医学论文-外伤性蛛网膜下腔出血的腰穿治疗.docVIP

医学论文-外伤性蛛网膜下腔出血的腰穿治疗 【摘要】? 目的 探讨腰穿对外伤性蛛网膜下腔出血后脑血管痉挛的防治效果。方法 选择以Fisher分级it-IV级的外伤性蛛网膜下腔出血且不具备手术指征的患者90例。出现延迟性缺血性神经功能障碍的症状与体征时（不包括脑外伤再出血、脑积水、水电解质紊乱等）,同时经脑多普勒(Traps crania lD oppler，TCD，检查大脑中动脉平均流速(V.MCA) 1 20cm/s确诊为脑血管痉挛。结果 每日分2～3次行腰穿共排放血性脑脊液总量80～122.5ml，平均（102.3±0.71）ml，连续7～10天，发生症状性血管痉挛8例，均在治疗后5天内缓解;痊愈52例，中残14例，重残10例，植物生存11例，死亡3例;出现脑梗死2例，无脑积水发生。结论 外伤性蛛网膜下腔出血后连续腰穿排放血性脑脊液清除蛛网膜下腔致痉挛物质，可以预防和缓解血管痉挛，是外伤性蛛网膜下腔出血有效的治疗措施。 【关键词】? 外伤性蛛网膜下腔出血;脑血管痉挛;腰穿 ??? 【Abstract】? Objective? To explore prevention and cure effect cerebral angio spasm after traumatic subarachnoid hemorrhage for l.p.(lumbar puncture).Methods? by means of? 90 case Fisher grade it-IV class traumatic subarachnoid hemorrhage and no have operation Indic. Symptom and objective of retardance? electrolyte? nerves handicapped,(beside? cerebral trauma? Rehaemorrhagia, hydrocephaly, electrolyte disturbances and so on)? at the same time Brain Dopple? to check? up? arteria cerebri media mean glow velocity diagnosis cerebral angio spasm.Results? l.p.(lumbar puncture) (divla.two-three) discharge uprightness C.S.F total amount 80-122.5 mil, average 102.3±0.71, continuous 7～10 days, to happen Symptom? vasospasm 8 case, anesis post-treatment in 5 days,recovery 52 case,midst incomplete 14 case, weight incomplete 10 case, plants exist 11 case, death 3 case, cerbral infarction 2 case , no happing dropsy of brain.Conclusion? post traumatic subarachnoid hemorrhage continuous l.p discharge uprightness C.S.F to get rid of cavitas subarachnoidealis the the material of convulsion, that will do obviate and relieve vasospasm, it is a effective? therapeutic measure to traumatic subarachnoid hemorrhage. ??? 【Key words】? traumatic subarachnoid hemorrhage;cerebral angio spasm;continuous l.p. ??? 脑血管痉挛是外伤性蛛网膜下腔出血患者的主要并发症之一，影响颅脑外伤患者的预后。如何预防外伤后脑血管痉挛的发生和缓解脑血管痉挛的程度是神经外科医生必须面对的难题［1］。本文采用连续腰穿排放血性脑脊液治疗外伤性蛛网膜下腔出血以探讨其实用性与有效性。 　　1? 资料与方法 ??? 1．1? 一般资料? 我院自2005年1月—2008年5月，应用腰穿治疗外伤性蛛网膜下腔出血 90例，男56例，女34例，年龄19～58岁，平均34岁。致伤原因:交通事故65例，击打伤15例，坠落伤10例，外伤至入院均在24h