脑脊液置换治疗蛛网膜下腔出血后脑血管痉挛的临床分析.doc

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1、脑脊液曾换治疗蛛网膜下腔出血后脑血管痉挛的临床分析作者：张乃崇，赖廷海单位：广东省茂名市人民医院神经外科，广东茂名【摘要】目的：探讨脑脊液置换治疗外伤性蛛网膜下腔出血后脑血管痉挛的临床疗效。方法：选取2005年1月至12月我院神经外科20例外伤性蛛网膜下腔出血患者，全部采用脑脊液置换并鞘内注射地塞米松综合性治疗。结果：全部病例均在腰穿脑脊液置换并鞘内注射地塞米松后阵发性剧痛立即缓解，缓解率100%。但仍有可忍受之持续性钝痛。8例在治疗后12h需使用止痛药方能入睡。3〜5d后阵发性剧痛逐渐减弱，一•般

2、需作腰穿脊液置换5〜7d后阵发性剧痛逐渐消失，而持续性钝痛则在3〜4周后方诃基本完全消除。20例患者全部治愈出院，治愈率100%o结论：早期采取脑脊液置换术联合地塞米松鞘内注射治疗可降低脑血管痉享发生率，改善病人预后。对脑血管痉挛的治疗尤其是对其阵发性剧痛的缓解应以综合治疗为主。【关键词】蛛网膜下腔出血；脑血管痉挛；脑脊液置换；鞘内注射ClinicalAnalysisonCerebralVasospasmTreatedbyCerebrospinalFluidReplacementinPatients

3、withSubarachnoidHemorrhageZHANGNai-chong,LAITing-hai(ThePeople'sHosptialofMaoming,GuangdongMaoming525000,China)Abstract:Objective:Tostudytheeffectofcerebralvasospasmtreatedbycerebrospinalfluidreplacementinpatientswithsubarachnoidhemorrhage.Method:20cas

4、estraeumaticsubarachnoidhemotThage(SAH).whowereinchargedfromJan.toDec.2005inneurosurgeryDept,inourhospital,weretreatedbyintrathecalinjectioncombinedcerebralspinalfluidreplacement.Result:Alltheparoxysmalmegalgiawererelieved(relieveratewas100%)aftercereb

5、rospinalfluidreplacementthroughlumbarpunctureandintrathecalinjection,while,thereVesomecasesstillwithdullpain.8caseswereasleepafter12hoursofapplyinganalgesicdrug.Theparoxysmalmegalgiawasnotobviouseafter3〜5days.Itwasdisappearedafter5〜7daysofcerebrospinal

6、tlaidreplacementthroughlumbarpuncture,Howeverthecontinousdullpainwasdisappearedthoroughlyafter3~4weeks.20caseswerecuredandthendischarged.Conclusion:Itcandecreasetheoccurrencerateofcerebralvasospasmbycerebrospinalfluidreplacementcombinedintrathecalinjec

7、tion.Thecombinedtherapyisbettertocerebralvasospasmesp.fortheparoxysmalmegalgia.Keywords:Subarachnoidhemorrhage;Cerebralvasospasm;Cerebrospinalfluidreplacement;Intrathecalinjection蛛网膜下腔出血是神经外科常见急症，致死率较高，脑血管痉挛(Cerebralvasospasm,CVS)是蛛网膜下腔出血(Subarachnoidh

8、emorrhage,SAH)最重要的并发症，常于SAH后4~12d内发生,在发病3d或3周也町见到，血管痉挛占全部动脉瘤性SAH的70%,死亡率为无血管痉挛的1.5〜3倍，继发于脑血管痉挛后的脑缺血与迟发性缺血性损伤是SAH死亡的主要原因，尤其是外伤性蛛网膜下腔出血患者脑血管痉挛的发生率可高达40%〜80%［门。脑血管痉挛发生机理较为复杂，而临床治疗颇为棘手。选取2005年1月至12月收治的20例症状性脑血管痉挛病例分析报告如下。1资料与方法1.1一般资料：选取200