【www.zhangdahai.com--经济论文】
【摘要】 目的 研究脑脊液置换联合尼莫地平、地塞米松鞘内注射治疗蛛网膜下腔出血(SAH)的治疗作用。方法 将127例SAH患者随机分为试验组和对照组;对照组应用镇静、止痛、药物(EACA、尼莫地平片)等常规治疗方法,试验组在常规治疗的基础上,应用腰穿脑脊液置换和鞘内注射尼莫地平、地塞米松。结果 SAH的头痛症状以及脑积水、蛛网膜粘连、脑血管痉挛等主要并发症的发生率、死亡率,试验组明显少于对照组,经统计学处理,有统计学差异。结论 脑脊液置换联合尼莫地平、地塞米松鞘内注射治疗蛛网膜下腔出血,可明显降低SAH主要并发症的发生率和死亡率,其方法简便,效果可靠,有非常实用的临床价值。
【关键词】蛛网膜下腔出血;脑脊液置换;尼莫地平;地塞米松;鞘内注射;疗效
Analysis of Curative Effect about Combining Exchange of Cerebrospinal Fluid with Intrathecal Injection in Nimodipine and Dexamethasohe(D.X.M)for Subarachnoid Hemorrhage
XIANG Jian-guo,LU Wei.The First People Hospital of PingJiang,HuNan 414500, China
【Abstract】 Objective To examine the therapeutic effect about combining exchange of cerebrospinal fluid with intrathecal injection in Nimodipine and D.X.M for subarachnoid hemorrhage. Methods One hundred and twenty-seven patients were divided randomly into two groups:control group and test group. Both groups were given routine treatment, such as mitigation, acesodyne and medicament, for example, EACA and Tab Nimodipine, but the test group was cured by intrathecal injection of exchange of cerebrospinal fluid and intrathecal injection of nimodipine and D.X.M of treatment additionally. Results The incidence of occurrence and mor-
�
作者单位:410400湖南省平江县第一人民医院
tality of headache, bydrocephalus and Cerebral vasospasm in test group werw significantly lower than those in control group, and the difference had statistic value. Conclusion Combining exchange of cerebrospinal fluid with intathecal injection in Nimodipine and D.X.M is a good way on the treatment of SAH which can be widely used in Clinical.
【Key words】 Subarachnoid hemorrhage;Evhange of cerebrospinal fluid; Nimodipine and D.X.M; Intrathecal injection; Curative effect.
蛛网膜下腔出血(subarachnoid hemorrhage, SAH)又称为原发性蛛网膜下腔出血,是最常见的脑血管意外之一;其急性期并发症主要有脑血管痉挛、急性交通性脑积水、再出血等,严重威胁患者的生命和致残后降低患者的生存质量。对临床上怀疑有蛛网膜下腔出血的患者均应进行CT、腰穿、脑血管造影等辅助检查,以求尽早明确诊断,确定出血来源。但在一些基层医院,由于不能做脑血管造影,故不能在发病早期进行动脉瘤栓塞治疗,如何帮助这些患者度过急性期、降低死亡率以及并发症,是基层医院面临的重要课题之一。通过对127例蛛网膜下腔出血的患者分别进行脑脊液置换联合鞘内注药治疗以及常规治疗对照,前者获得了满意的疗效。
1 资料与方法
1.1 临床资料 病例的筛选参照中华医学会第四届脑血管病会议确定的蛛网膜下腔出血的诊断标准[1]。病例来源于湖南平江县第一人民医院2009年8月至2009年8月收治的127例均经过头颅CT扫描或腰穿证实的蛛网膜下腔出血患者。将患者随机分为试验组和对照组,其中试验组65例男35例,女30例,年龄范围19～68岁,平均40.3岁;对照组62例男性3例,女29例,年龄范围21～67岁,平均39.1岁。两组患者出血范围、出血部位、头痛评分、治疗时机差异均无统计学意义。
1.2 方法对照组患者在急症入院后仅采用常规治疗,包括绝对卧床休息,给予镇静、止痛、保持大小便通畅、抗纤维蛋白溶解药(EACA)以防止再出血,钙离子拮抗剂尼莫地平片40 mg/次,3次/d防止脑血管痉挛,20%甘露醇静脉输注脱水降颅压等。
试验组患者在常规治疗的基础上,分次给予腰穿脑脊液置换和鞘内注射尼莫地平2 mg/次和地塞米松5 mg/次。具体方法如下:①术前快速静脉输注20%甘露醇125 ml;②30 min后做腰穿,测颅内压,若压力≥150 mm H2O,则采用不等量置换,即放出5 ml脑脊液后注入4 ml生理盐水;若压力
表1
两组患者头痛评分比较(x±s)
组别例数 治疗前 第2天第4天第7天
对照组623.05±0.363.11±0.743.02±0.522.96±0.61
实验组653.06±0.682.87±0.522.7±0.492.27±0.45
注:与对照组比较,*P
