早期脑脊液置换治疗原发性蛛网膜下腔出血38例临床观察

目的 观察早期脑脊液置换加小量尿激酶和地塞米松椎管内注射治疗原发性蛛网膜下腔出血的疗效及安全性.方法 将74例病人随机分为置换组38例,对照组36例.置换组腰椎穿刺行脑脊液置换,置换总量每次35ml;对照组只做常规腰穿检查,不做脑脊液置换.观察指标血红蛋白(Hb)每日清除率及第7d总清除率、头痛缓解时间、大脑中动脉平均血流速度(VMMCA)、并发症及治疗效果评价等.结果 置换组Hb每日清除率及第7d总清除率分别为16.27%和97.6%,对照组分别为13.9%和83.6%,2组具有显著性差异(P＜0.05).头痛缓解时间较对照组明显缩短(P＜0.05),分别为3.35d和12.28d.置换组大脑中动脉平均血流速度较对照组显著增加(P＜0.05).置换组并发脑血管痉挛(5.26%)、脑积水(2.63%)的发生率较对照组(分别为22.2%和19.44%)显著降低(P＜0.05).再出血的发生率无显著差异;治疗组(86.84%)总有效率较对照组(69.44%)显著提高.结论 早期脑脊液置换加小量尿激酶和地塞米松椎管内注射治疗是原发性蛛网膜下腔出血、预防脑血管痉挛及脑积水发生的有效安全方法之一.

Combining early exchange of cerebrospinal fluid with small dose of urokinase injection and dexamethasone for subarachnoid hemorrhage

Objective To explore the curative effects of combining exchange of cerebrospinal fluid with small dose of urokinase and dexamethasone injection for the treatment of subarachnoid hemorrhage(SAH).Methods Seventy-four SAH patients diagnosed by CT and lumbar puncture were randomly divided into two groups:38 patients in the treatment group were given exchange of cerebrospinal fluid and small dose of urokinase and dexamethasone injection;36 patients in the control group were treated without exchange of cerebrospinal fluid.Hb clear rate,headache disappear time,TCD,the main complications and curative effect of the two group were compared.Results Hb clear rate were 16.27% in every day and 97.6% in total 7 day,significantly more than that in control group(P<0.05);headache disappear time shorten in treatment group more than that in control group(P<0.05);comlications about cerebral vasopasm and hydrocephalus were fewer than those in the conventional therapeutic group(P<0.05),and there was no significant difference in the incidence of rebleeding between the two groups(P<0.05).There was obvious difference the curative effect in the two groups(P<0.05).Conclusion Combining exchange cerebrospinal fluid with small dose of urokinase and dexamethasone injection is an effective method for treating SAH,and it can improve the survival rate and life quality of SAH patients.