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原发性蛛网膜下腔出血(SAH)若在治疗中发生再次出血,便会导致严重后果。现将本院1985年两例病案提出讨论。例一杨×,女,43岁,总工程师。因猛力扶持一突然昏倒的病人后,出现持续性剧烈头痛,伴呕吐、眼胀两天。于1985年4月29日门诊以“头痛原因待查”入院。经取脑脊液三管共5毫升皆为深血性而确诊为原发性珠网膜下腔出血。治疗经过:给脱水剂后头痛有所减轻,同时予以抗纤溶止血及对症处理。5天后查脑脊液,外观黄色,镜检无红血球。两周后头痛基本控制,眼胀及恶心呕吐消失,颈软,一般情况尚可。第16日,因换床单反复下床、站立及用力排便后,于晚10时,突然抽搐,角弓反张,口角右斜,小便失禁。半分钟后,抽搐停止,血压140/90毫米汞柱。神志萎靡,语言表达困难。颈抵抗明显,无面、舌瘫,右上肢肌力Ⅱ
Primary subarachnoid hemorrhage (SAH) If bleeding occurs again during treatment, serious consequences can result. Now two medical cases in our hospital were discussed in 1985. Example a Yang ×, female, 43 years old, chief engineer. Due to fierce support for a sudden collapse of the patient, sustained severe headache, vomiting, swollen eyes for two days. On April 29, 1985, the outpatient department was admitted to the hospital with the cause of headache to be investigated. Take three cerebrospinal fluid 5 ml were deep bloody and diagnosed as primary subretinal hemorrhage. After treatment: to dehydration agent headache has been alleviated, while anti-fibrinolytic hemostasis and symptomatic treatment. After 5 days to check cerebrospinal fluid, the appearance of yellow, microscopic examination without red blood cells. Two weeks after the basic control of headache, eye swelling and nausea and vomiting disappeared, neck soft, the general situation is acceptable. On the 16th, due to bed sheets repeatedly get out of bed, standing and forced defecation, at 10 o’clock in the evening, suddenly convulsions, corner arch anti-Zhang, right angle diagonal mouth, urinary incontinence. Half a minute later, convulsions stopped and blood pressure was 140/90 mmHg. Consciousness, language difficulties. Neck resistance is obvious, no face, tongue paralysis, right upper limb muscle strength Ⅱ