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我们从1995年1月至1998年1月采用颈椎侧方穿刺下行脑脊液(CSF)置换法和椎管内注射激素,治疗蛛网膜下腔出血(SAH)12例均取得较好临床效果。现报告如下。1 临床资料1.1 一般资料 12例病人中男8例,女4例。其中20～50岁4例,50岁以上6例;最大70岁,最小15岁。所选病人均经头颅CT确诊为原发性SAH。入院时昏迷2例,动眼神经麻痹3例,偏瘫2例。1.2 方法 术前注意观察病人神志、呼吸、脉搏、血压及瞳孔情况。术前半小时先快速静滴20％甘露醇加速尿20～40mg,对于躁动不安者肌注安定10～15mg;严格无菌操作,常规颈穿成功后先测CSF压,随之缓慢放出血性CSF5～10ml,而后再椎管内注入生理盐水5～10ml,然后重复上法2～3次,直至每次置换总量达20～30ml为止,最后一次不再注入生理盐水而注入地塞米松5mg,隔天1次(在颈部两侧
From January 1995 to January 1998, we used lateral cervical puncture cerebrospinal fluid (CSF) replacement and intraspinal intratracheal injection of hormones in the treatment of 12 cases of subarachnoid hemorrhage (SAH) have achieved good clinical results. The report is as follows. 1 Clinical data 1.1 General Information 12 patients, 8 males and 4 females. Of which 20 to 50 years in 4 cases, 50 years of age in 6 cases; up to 70 years old, the youngest 15 years old. The selected patients were diagnosed as primary SAH by skull CT. 2 cases of coma on admission, oculomotor nerve paralysis in 3 cases, 2 cases of hemiplegia. 1.2 Methods Preoperative attention to observe the patient consciousness, breathing, pulse, blood pressure and pupil situation. Half an hour before the rapid intravenous infusion of 20% mannitol to speed up the urine 20 ~ 40mg, restless restless muscle intramuscular stability 10-15mg; strict aseptic operation, the conventional neck piercing after the first test CSF pressure, followed by the slow release of bloody CSF5 ~ 10ml, and then injected into the spinal canal normal saline 5 ~ 10ml, and then repeated on the law 2 or 3 times, until each replacement of up to 20 ~ 30ml so far, the last injection of dexamethasone no longer injected saline 5mg, 1 day (on both sides of the neck