大剂量脑脊液等量置换及椎管内尿激酶注射救治蛛网膜下腔出血的临床研究

A clinical study of intraspinal injection of urokinase and exchange of cerebrospinal fluid for treatment of subarachnoid hemorrhage

目的 探索救治蛛网膜下腔出血 (SAH)患者的有效方法。方法 对经头颅螺旋CT或磁共振成像及腰穿确定 ,有剧烈头痛、恶心、呕吐 ,应用常规降颅压及止痛无效的 2 8例SAH患者 ,用大剂量生理盐水置换脑脊液和椎管内尿激酶注射治疗 ,并与对照 1组单纯大剂量脑脊液置换 10例和对照 2组单纯小剂量生理盐水置换脑脊液 12例进行比较。结果 治疗组 18例即刻 (1h)、2 4h、72h、5d症状明显减轻至消失 ,72h缓解 2 7例 (96 .4 %) ,所有患者均未出现速发或迟发性脑血管痉挛 (CVS)现象。对照 1组 10例 72h缓解 6例 (6 0 %) ,1例发生迟发性CVS征象 ,与治疗组比较差异有显著性意义 (P <0 .0 5 )。对照 2组 2例 2 4h内症状明显减轻 ,72h基本缓解 ,其他患者症状持续时间均在 72h以上 ,最长持续达 1周 ,4例 (33%)发生迟发性CVS ,死亡 2例。结论 应用大剂量生理盐水置换脑脊液可快速消除SAH患者之急性症状 ,对CVS也有较好治疗和预防作用 ,而早期加用小剂量尿激酶椎管内注射 ,可以明显提高以上疗效 。

Objective To investigate the effect of cerebrospinal fluid(CSF) exchange and intraspinal injection of urokinase(UK) on the subarachnoid hemorrhage (SAH).Methods Twenty eight patients with SAH diagnosed by CT or MRI,who did not respond to common treatment such as lowering of intracranial pressure and relieving pain,were given large dose of normal saline to exchange 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 12 cases in control group 2 were given small dose of normal saline to exchange CSF.Results In treatment group,18 cases had symptoms relieved at one hour after treatment,9 cases had symptoms relieved at 24 hours and completely relieved at 72 hours.The relieving rate at 72 hours was 96.4%(27/28).No patient had late cerebral vascular spasm.In control group 1,6 cases had symptoms relieved at 24 hours and completely relieved at 72 hours.The relieving rate at 72 hours was 60%(6/10).One case had late cerebral vascular spasm,which had significant difference to the treatment group (P<0.05).In control group 2,2 cases had symptoms relieved at 24 hours and completely relieved at 72 hours.The other cases had no symptom relief within 72 hours.Four cases had late cerebral vascular spasm,with an incidence of 33%(4/12).Two patients died.Conclusions The symptoms of SAH patients were quickly relieved by large dose of CSF exchange and small dose of UK injection,which also could prevent cerebral vascular spasm.Three month follow up showed no relapse.