原发性蛛网膜下腔出血的内科综合治疗

目的：总结原发性蛛网膜下腔出血(SAH)的内科综合治疗经验。方法：根据早期头颅CT显示SAH部位，对69例原发性SAH患者采用前列腺素E1脂微球制剂、尼莫通、止血药等药合用和／或腰穿脑脊液置换术进行综合治疗。结果：SAH死亡率21．74％，发病时有意识和或精神障碍、尿便失禁、高血压病者预后较差。早期头颅CT显示SAH部位在大脑半球表面沟裂、中脑周池、桥池、环池或脑室内者预后较差，且容易继发脑损害。结论：根据早期头颅CT显示SAH部位选用综合治疗措施，能够降低死亡率、减少继发脑损害。

A research for the internal medical combined treatment of primary subarachnoid hemorrhage

Objective:To summarize the experience in the internal medical combined treatment of primary subarachnoid hemorrhage (SAH). Methods: 69 in-patients with their bleeding location identified by CT scanning, were treated with the combination of LipoPGE 1?Nimotop ?PAMBA and/or with lumbar puncture and the replacement of CSF. Results:The mortality was 21.74%. Patients with conscious and/or mental disorders, fecal and urinary incontinence as well as hypertension at the onset had poor prognosis. The locations of hemorrhage showing on early CT scanning such as at the fossa and fissure on the surface of brain, basal cistern, pontine cistern, ambient cistern or intraventricle were associated with poor prognosis and would easily have secondary brain injury. Conclusion:The combined internal medical treatment selected by the SAH location showing on the early brain CT could decrease the mortality and reduced secondary brain injury.