外伤性蛛网膜下腔出血致急性心肌梗死1例

患者女性,63岁,跌倒后突发神志不清6 h入院.门诊急查头颅CT示:两侧额颞硬膜下血肿,蛛网膜下腔出血.于2004年3月19日晚10点急诊入院,否认高血压、冠心病、糖尿病等病史.体检:T 38.0℃,R24次/min,HR 140次/min,BP 150/90mmHg,昏迷,双瞳不等大,左0.1 cm,右0.3 cm,对光反射迟钝,颈无抵抗,呼吸快而深且不规则,两肺呼吸音粗,双下肺有少许湿啰音,心界不大,HR 140次/min,律齐,各瓣膜区未闻及杂音,腹平软.     

甘露醇致老年患者急性肾损害41例临床分析

甘露醇为渗透性利尿剂,主要经肾代谢,静脉注射该药后血浆渗透压升高,造成组织脱水,从而产生渗透性利尿作用,故成为目前临床上降颅压的首选用药.但由于用量、给药速度及患者年龄差异,临床应用过程中会出现不良反应,下面仅就我院41例60岁以上老年患者在应用甘露醇过程中发生肾脏损害情况进行分析.     

酒后被殴致蛛网膜下腔出血

【病例】男,25岁。酒后意识不清1小时入院。查体:体温38·5℃,脉搏42/m in,血压40/20 mmHg。意识模糊,呼吸浅,呼吸音听不清,颜面发绀。无口眼歪斜,颈软,瞳孔散大、对光反射消失。心率42/m in,律齐,四肢发绀、湿凉。即给纳铬酮0·4 mg、肾上腺素1 mg、阿托品0·5 mg、利多卡因100 mg静脉推注,并行胸外心脏按压、口对口人工呼吸。按压时吐出咖啡色胃内容物约200 g,有酒精气味。为防窒息行俯卧位拍背催吐,又吐出胃内容物约200 g,吸出300 m l胃内容物,此时脉搏21/m in,瞳孔散大。予5%碳酸氢钠50 m l静脉推注;予电除颤3次,肾上腺素2 mg、阿托品1…     

急性蛛网膜下腔出血时的心电图改变

急性蛛网膜下腔出血时的心电图改变姚依群刘芳龄崔吉君王晓明急性蛛网膜下腔出血（ＳＡＨ）患者经常表现有心电图异常，有时甚至出现危及生命的心律失常。为了更好地提高救治的成功率，我们对６５例急性蛛网膜下腔出血患者的心电图资料作如下分析。１资料与方法１．１临床...     

蛛网膜下腔出血的临床表现分析

目的:为进一步探讨蛛网膜下腔出血的临床表现及导致临床误诊的原因。方法:本文分析了本院收治86例原发性蛛网膜下腔出血的临床表现及检查结果。结果:具有蛛网膜下腔出血的典型临床表现占55.8％;而以发热、头晕、颈背痛、双下肢痛、肢体无力、腹痛腹泻等为首发症状的占44.2％。CT的阳性率为86.7％。结论:非典型的临床表现是造成误诊的常见原因。对怀疑病例应尽早行腰穿检查,并行CTA、MRA、DSA等影像学检查以明确病因。     

年龄对蛛网膜下腔出血的影响

目的：探讨急性期蛛网膜下腔出血（subarachnoid hemorrhage,SAH)患者的年龄对预后的影响。方法：将120例患者分为青、中、老年3个年龄组,采用趋势χ^2检验各年龄组的病因、慢性疾病史、急诊时的状况、临床经过及治疗结果等与预后相关的因素进行分析。结果：急诊时患者的意识水平随年龄增高而恶化（P＜0．01）,年龄也与急诊时出现血压增高（P＜0．01）,及CT片显示的出血量（P＜0．05）、脑室内出血（P＜0．01）相关。既往所患的慢性疾病史如：高血压、冠心病、糖尿病及肺部疾病与年龄相关。结论：年龄增高是SAH预后较差的一个重要独立指标,并与多种因素密切相关。     

脑脊液置换术治疗急性蛛网膜下腔出血的护理

脑脊液置换术是治疗蛛网膜下腔出血的良好方法之一。我院从１９９８年３月～２０００年２月共行脑脊液置换术９例 ,取得了确切的临床效果 ,现将护理体会报告如下。１临床资料１．１一般资料治疗组９例 ,男５例 ,女４例。平均年龄６１岁。对照组９例 ,在同一时间内随机抽取 ,其中男５例 ,女４例。平均年龄５６岁。１８例患者均符合中华医学会第四次脑血管病会议确定的诊断标准。均行头部ＣＴ检查确诊 ,而且配合常规方法止血、防脑动脉痉挛等对症治疗。１．２护理及方法１．２．１术前准备做好术前准备工作是减少并发症的重要环节之一。病人入…     

急性药物中毒致假性蛛网膜下腔出血1例

1 病历摘要 患者女,27岁,因服用多种药物(头孢氨苄20片,丹参片10片)后头痛伴嗜睡2 h来我院急诊.在急诊洗胃后恶心、呕吐2次.行头部CT检查示:右侧外侧裂、鞍上池边缘及大脑纵裂密度增高,第三脑室显示不清,余脑质形态、密度未见异常.     

自发性蛛网膜下腔出血104例临床分析

蛛网膜下腔出血 (ＳＡＨ)是神经内科急症 ,发病率占所有中风的 5 %～ 10 % [1] ,可发生于任何年龄。本院内科 1992年 1月至 1999年 12月共收治ＳＡＨ 10 4例 ,现将其临床特点报道如下。1　临床资料1.1　一般资料　本组 10 4例 ,男 5 9例 ,女 4 5例 ,年龄19～ 77岁 ,<60岁者 66例 ,≥ 60岁者 38例。有发病诱因者 63例 (60 .6% ) ,其中排便时发病 9例 ,劳动或用力时发病 4 5例 ,情绪激动时发病 6例 ,饮酒后发病 2例 ,头部撞到床上时发病 1例。无明显诱因者 4 1例(39.4 % )。起病到就诊时间为数小时至 14ｄ。首次出血者 93例 (89.4 % ) ;第 2次…     

自发性脊髓蛛网膜下腔出血1例分析

现对自发性脊髓蛛网膜下腔出血1例分析如下。     

Early rehabilitation in patients with acute aneurysmal subarachnoid hemorrhage

Abstract

Purpose: The aim of this study was to describe and quantify the content of early rehabilitation adapted to patients with acute aneurysmal subarachnoid hemorrhage (aSAH) and to assess its feasibility. Methods: This was a prospective, observational study including 37 aSAH patients. Early rehabilitation was applied according to a mobilization algorithm. Clinical parameters, the time that rehabilitation team used on early rehabilitation and progression in mobilization were recorded. The patients’ clinical conditions were graded according to the World Federation of Neurological Surgeons scale (WFNS). Results: Poor-grade patients (WFNS 3, 4, 5) (n?=?12) received more rehabilitation (median 412?min) than did good-grade patients (WFNS 1, 2) (median 240?min). Mobilization to 60° of head elevation in good-grade patients began on day one after securing the aneurysm. Out-of-bed mobilization was possible on day three. Poor-grade patients were mobilized to 60° after two days and were out of bed on day seven. At discharge, 67% of poor-grade patients were mobilized to walking versus 78% of good-grade patients. No serious adverse effects to early rehabilitation were observed. Conclusions: Early rehabilitation in aSAH patients is feasible from the first day after securing the aneurysm. The rehabilitation content varied according to the patient’s clinical grade.

• Implications for Rehabilitation

• Early rehabilitation is feasible from the first day after securing the ruptured aneurysm in patients with aneurysmal subarachnoid hemorrhage (aSAH).

• Early rehabilitation requires close monitoring and continuous adjustment for the content and amount according to the patient’s clinical condition.

• Interdisciplinary collaboration is recommended to match the rehabilitation needs to the medical condition on a daily basis.

     

动脉瘤性蛛网膜下隙出血后急性脑积水患者的护理

蛛网膜下隙出血(subarachnoid hemorrhage,SAH)约占全部脑卒中的5%-10%.其中85%出血原因为颅内动脉瘤破裂[1,2].SAH后急性脑积水是指SAH后1周内发生的脑积水,是SAH后较为常见的并发症,发生率为9%～7%.可导致患者明显的神经功能损害,常加速病情进展甚至导致死亡.     

Myocarditis in patients with subarachnoid hemorrhage: A histopathologic study

Cardiac abnormalities after subarachnoid hemorrhage (SAH) such as electrocardiographic changes, echocardiographic wall motion abnormalities, and elevated troponin levels are independently associated with a poor prognosis. They are caused by catecholaminergic stress coinciding with influx of inflammatory cells into the heart. These abnormalities could be a sign of a myocarditis, potentially giving insight in pathophysiology and treatment options. These inflammatory cells are insufficiently characterized, and it is unknown whether myocarditis is associated with SAH. Myocardium of 25 patients who died of SAH and 18 controls was stained with antibodies identifying macrophages (CD68), lymphocytes (CD45), and neutrophil granulocytes (myeloperoxidase). Myocytolysis was visualized using complement staining (C3d). CD31 was used to identify putative thrombi. We used Mann-Whitney U testing for analysis.In the myocardium of SAH patients, the amount of myeloperoxidase-positive (P < .005), CD45-positive (P < .0005), and CD68-positive (P < .0005) cells was significantly higher compared to controls. Thrombi in intramyocardial arteries were found in 22 SAH patients and 1 control. Myocytolysis was found in 6 SAH patients but not in controls.Myocarditis, consisting of an influx of neutrophil granulocytes, lymphocytes, and macrophages, coinciding with myocytolysis and thrombi in intramyocardial arteries, occurs in patients with SAH but not in controls. These findings might explain the cardiac abnormalities after SAH and may have implications for treatment.     

自发性蛛网膜下腔出血后低钠血症的临床研究

目的 研究自发性蛛网膜下腔出血(SAH)患者低钠血症的发生情况.方法 对36例蛛网膜下腔出血患者按出血量、病情轻重、脑血管痉挛的情况及血钠水平进行动态观察.用TCD检测大脑中动脉血流速度(VMCA).结果 脑血管痉挛的患者其血钠水平明显降低,有明显的临床意义.结论 低钠血症是蛛网膜下腔出血常见的并发症,且是反映蛛网膜下腔出血病情程度的一个重要指标.应严密监测并及时明确病因、尽早治疗,以改善病情及预后.     

Insulin like growth factor-I in acute subarachnoid hemorrhage: a prospective cohort study

Introduction  

Neuroendocrine deficiencies may affect recovery after aneurysmal subarachnoid hemorrhage (aSAH). Insulin like growth factor-I (IGF-I) regulates neuronal growth and apoptosis in ischemic stroke. Our study was designed to a) characterize the behavior of serum IGF-I and growth hormone (GH) in the acute and late phases after aSAH reflecting possible pituitary gland function and b) evaluate the association between IGF-I and morbidity assessed by Glasgow outcome scale (GOS) and health related quality of life (HRQoL) in patients with aSAH.     

动脉瘤性蛛网膜下腔出血早期病因治疗与保守治疗效果的对照研究

目的探讨动脉瘤性蛛网膜下腔出血(SAH)后早期病因治疗与保守治疗对疗效及预后的影响。方法将84例动脉瘤性SAH患者按治疗方案的不同选择,随机分为两组,病因治疗组(A组,42例)：在急性出血期先对破裂的动脉瘤进行血管内栓塞,然后立即将SAH引流出；常规保守治疗组(B组,42例)。对照分析A、B两组的临床资料及疗效。结果A、B两组临床资料比较差异无统计学意义,具有可比性(P＞0．05)。A组GOS预后良好率明显高于B组,两组比较差异有统计学意义(χ~2=9．22,P＜0．01)；B组重残率高于A组,两组比较差异有统计学意义(χ~2=3．94,P＜0．05)；B组死亡率亦高于A组,两组比较差异有统计学意义(χ~2=3．90,P＜0．05)。结论动脉瘤性SAH后在急性出血期先对颅内动脉瘤进行血管内栓塞,然后立即将SAH引流出的治疗方法对提高该病的治愈率、改善预后和降低死亡率具有重要的意义。     

不同年龄急性心肌梗死患者的临床特点

目的　探讨不同年龄急性心肌梗死患者的临床特点。方法　将 2 2 2例急性心肌梗死患者 ,根据年龄不同分为 4组 :<6 0岁为非老年组 ,6 0～ 6 9岁为低龄老年组 ,70～ 79岁为中龄老年组 ,≥ 80岁为高龄老年组。分别对其临床表现进行比较分析。结果　非老年组中典型胸痛常见 (82 .1% )。老年各组随着年龄增加而有其独特表现 :临床症状不典型及多变性 ;梗死面积广泛 ;并发症多而危重 ;伴存疾病多 ;病死率高。结论　不同年龄急性心肌梗死临床表现各具特点 ,年龄越大 ,临床表现越不典型 ,病情越危重 ,预后不良。     

外伤性蛛网膜下腔出血患者血管痉挛状态的前瞻性临床研究

目的 探讨t-SAH患者中脑血管痉挛(CVS)的发生率、CVS的时间窗及危险因素.方法 前瞻性地对2007年6月至2008年12月期间绍兴县中心医院神经外科收治的t-SAH患者临床资料进行收集、分析,并于患者入院7 d内每天和第14天通过TCD观察大脑中动脉的血流动力学变化,以MCA平均血流速度(VmMCA)≥120 cm×s-1为CVS的标准,统计t-SAH患者中CVS的发生率、CVS的时间窗及相关的危险因素.结果 共98例t-SAH患者纳入本研究,CVS发生率为41.8%(共41例),其中GCS≤8分患者的MCA平均血流速度明显高于GCS≥9分患者;t-SAH积血Hijdra法计算6分以下45例(45.9%)中有2例(4.44%),6～13分31例(37.8%)中有9例(29.0%),13分以上22例(20.0%)中有8例(36.4%)发生CVS.手术组中37例(37.8%)中有13例(35.1%)发生重度CVS,通过对症治疗仍出现4例局部脑梗死,并入院3 d后的MCA平均血流速度明显高于非手术组.结论 t-SAH患者的原发伤程度、出血量及部位、手术操作等是导致CVS的主要危险因素,对t-SAH的防治有指导性意义.     

腰池持续引流治疗外伤性蛛网膜下腔出血

目的　评价腰池持续引流对外伤性蛛网膜下腔出血 (traumaticsubarachnoidhemorrhage ,tSAH)的治疗效果。方法　患者 2 38例 ,随机分为治疗组和对照组。治疗组 116例患者行腰池脑脊液持续引流 ,对照组 12 2例患者行腰穿放液。结果　治疗组和对照组患者脑脊液中红细胞 (RBC) <10 0× 10 6 /L的时间分别为伤后 (5 2± 2 6 )d和 (7 3± 3 8)d (P <0 0 1) ,两组脑脊液中蛋白 (TP) <0 8g/L时间分别为伤后(8 4± 3 8)和 (11 6± 4 6 )d ,治疗组伤后平均颅内压、甘露醇用量显著低于对照组 ,治疗组头痛、脑膜刺激征持续时间短 ,脑积水及脑梗塞发生率、病死率均显著低于对照组。结论　腰池持续引流可快速廓清tSAH患者的脑脊液 ,患者临床症状迅速减轻 ,并发症明显减少 ,预后改善。