以心跳骤停为首发症状的蛛网膜下腔出血共同特征研究

<正>心跳骤停（cardiac arrest,CA）和蛛网膜下腔出血（subarachnoid hemorrhage,SAH）均是急诊科常见的急危重症，CA可见于多种疾病的各个阶段，复苏成功率不高，甚至造成CA的病因不甚明确。SAH典型表现为剧烈头痛、呕吐、脑膜刺激征，诊断并不困难。而以CA为首发症状的SAH，由于心肺复苏无法常规进行头颅CT检查，给诊断增加了困难。本文通过对16例以CA为首发症状的SAH患者进行回顾性研究，来提高SAH-CA的快速病因诊断，避免漏诊误诊。

A study on the common characteristics of subarachnoid hemorrhage with cardiac arrest as the first symptomJiang yin sheng1 Sheng yi1 Ou wei gen1 Li feng1 Wu long chuan1 Yang dongdong2

Objective To explore the common characteristics of clinical manifestations, electrocardiogram and prognosis of patients with subarachnoid hemorrhage(SAH) with cardiac arrest(CA) as the first symptom, so as to provide a direction for rapid diagnosis of this kind of disease and avoid missed diagnosis.Methods Sixteen patients with SAH diagnosed with CA as the first symptom from January 2015 to December 2019 in the First Affiliated Hospital of Zhejiang Chinese Medical University and the medical consortium hospital were included, including 10 males and 6 females. The recovery time of the restoration of spontaneous circulation(ROSC),the characteristics of the first ECG after ROSC, the physical examination after ROSC and the common characteristics of the prognosis were analyzed.Results These patients have the following common characteristics1:1.ROSC can realized quickly,in a short time.2. After ROSC,consciousness was lost,without spontaneous breathing,pupil dilated and electroencephalogram showed static state; 3. The ECG prompt fast ventricular rate of atrial fibrillation and sinus tachycardia,ST elevation in aVR with large ST depression in chest Leads, which sinus rhythm also appeared ST depression in II, III, avF leads.In line with the above three points, the possibility of SAH should be considered first, and the skull CT should be performed to make a definite diagnosis. Conclusion ROSC can realized quickly by cardiopulmonary resuscitation, and the ECG showed ST-T changes,concurrent brain death,which may be characteristics of CA due to SAH.