脑脊液置换及椎管内注药治疗蛛网膜下腔出血后迟发性脑血管痉挛

Exchange of cerebrospinal fluid and intraspinal injection of urokinase for treatment of delayed cerebral vascularspasm following subarachnoid hemorrhage.

目的探讨救治蛛网膜下腔出血(SAH)后迟发性脑血管痉挛(DCVS)的有效方法。方法治疗组用大剂量生理盐水置换脑脊液并椎管内尿激酶注射治疗20例,并与对照1组单纯大剂量生理盐水等量脑脊液置换10例和对照2组单纯小剂量生理盐水置换脑脊液10例进行比较。结果治疗组2、3d症状明显减轻至消失,均未出现DCVS。对照1组中4例5d、6例7d症状减轻至消失,均未出现DCVS。对照2组中2例7d症状减轻至消失,未出现DCVS;8例发生DCVS,其中6例中度病残,2例死亡。结论应用大剂量生理盐水置换脑脊液可快速消除蛛网膜下腔出血患者的急性症状,对DCVS也有较好预防和治疗作用,而早期加用小剂量尿激酶椎管内注射,可以明显提高疗效,同时又不会增加再出血的危险。

Objective To investigate the effective way to treat delayed cerebral vascularspasm (DCVS) following subarachnoid hemorrhage (SAH).Methods 20 patients with SAH were given large dose of normal saline to exchange cerebral spinal fluid(CSF)and injection of urokinase into vertebral canal.Two control groups were designed to compare with the treatment group.Ten cases in control group 1 were given large dose of normal saline to exchange CSF and the other ten cases in control group 2 were given small dose of normal saline to exchange CSF.Results In treatment group 20 cases had symptoms relieved on 2-3d and no patient developed DCVS.In control group 1,4 cases had symptoms relieved on 5d,and 6 cases on 7d,and no patient developed DCVS.In control group 2,2 cases had symptoms relieved on 7d and did not develop DCVS but other 8 cases developed DCVS,6 of whom were moderately disabled and 2 died.Conclusion Large dose of normal saline to exchange CSF can quickly relieve the acute symptoms of SAH,which can better prevent and treat DCVS.Early addition of small dose injection of urokinase can remarkably increase the therapeutic effect and donot increase the risk of rehemorrahge.