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患男,56岁,因突发意识障碍1h,频繁呕吐,大小便失禁入院。既往无高血压病史。查体:深昏迷,呼吸停顿,右瞳孔5mm,光反射消失,左瞳孔3mm,直接光反射迟顿,间接光反射消失。四肢肌张力高,生理反射消失,巴氏征双侧强阳性。CT:右基底节外侧血肿102ml,中线移位20mm。拟诊:大脑动脉瘤破裂伴镰下疝形成。亨氏分级5级。急诊行开颅血肿清除,见基底节外侧血肿腔底部有1.5cm×1cm凝血块粘附,考虑为动脉瘤破裂口。控制性低血压12/8kPa,仔细剥离凝血块后,动脉血喷涌,强负压吸除,显露瘤颈破裂口约6mm。夹闭一支供血动脉后,血压降为零,棉片压迫止血,血压平稳后夹闭其余3支供血动脉。二次术中血压为零累计30min。术后3d清醒、2个月后数字减
Suffering from male, 56 years old, due to sudden consciousness disturbance 1h, frequent vomiting, incontinence admitted to hospital. No previous history of hypertension. Physical examination: deep coma, breathing pause, right pupillary 5mm, light reflexes, left pupil 3mm, direct light reflex delay, indirect light reflex disappears. The limbs have high muscle tone, physiological reflexes disappeared, and the Pakistani’s sign is strongly positive on both sides. CT: lateral hematoma of the right basal ganglia was 102 ml and the midline shift was 20 mm. To be diagnosed: rupture of cerebral aneurysm with formation of suborbital hernia. Heinz grade 5 The craniotomy hematoma was removed in the emergency department. See 1.5cm×1cm clot adhesion at the bottom of the lateral hematoma cavity of the basal ganglia. Consider the rupture of the aneurysm. Controlled hypotension 12/8 kPa, carefully peeled blood clot, arterial blood spewing, strong suction suction, revealed about 6mm rupture neck neck. After clamping a blood supply artery, the blood pressure dropped to zero, and the cotton piece pressed to stop the blood. After the blood pressure became stable, the remaining three blood supply arteries were clamped. In the second surgery, the blood pressure was accumulated for 30 minutes. Awakened after 3 days after surgery, and decreased after 2 months