脑脊液置换及鞘内注射地塞米松治疗蛛网膜下腔出血的疗效分析

Effect analysis of subarachnoid hemorrhage treated with cerebrospinal fluid permutation and dexamethasone injection into spinal cord sheath

目的观察脑脊液(CSF)置换法及鞘内注射地塞米松治疗蛛网膜下腔出血(SAH)的疗效.方法在常规治疗的基础上,行腰椎穿刺,缓慢放出血性脑脊液4～6 ml,再缓慢注入等量生理盐水,如此反复置换后加地塞米松5 mg鞘内注射.结果除2例分别因再出血致脑疝死亡及上消化道大出血死亡外,29例置换后头痛等临床症状能迅速缓解,平均5.3 d.较对照组11.2d明显缩短,死亡率也明显降低.结论脑脊液置换法配合鞘内注射地塞米松的应用可缓解头痛,减轻脑水肿、防止蛛网膜粘连、脑积水和脑血管痉挛,减少并发症,缩短病程,提高治愈率.

Aim To observe the effeet of cerebrospinal fluid（CSF） permutation and dexamethasone injection into spinal cord sheath to treat subarachnoid hemorrhage（SAH）. Methods Lumbar puncture was performed to 31 cases of SAH based on routine therapy, and CSF mixed with blood were let out about 4-6 ml, and then 0.9% NS was put in with the same quantity of 5 mg dxamethasone was injected into spinal cord sheath after repeated permutation for some time. Results Clinical symptom such as headache etc. could remitted rapidly in 29 cases of SAH after permutation on average 5.3 days which was shortened markedly in comparison with control group 11.2 days, and also mortality decreased markedly. Only two cases died from cerebral hernia due to second hemorrhage and hematorrhea from upper digestive tract respectively. Conclusion The method of CSF permutation cooperated with injecting dexamethasone into cord sheath could remit headache , alleviate cerebral edema, prevent sarachnoid adherence,hydrocephalus and cerebrovascular spasm,reduce complication, shorten disease course, and increase curability.