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目的 :探讨抗纤溶剂、钙拮抗剂在自发性蛛网膜下隙出血 (SAH)患者的治疗作用。方法 :对 12 0例SAH病人进行病情评估 ,随机分为 :氨甲苯酸 (止血芳酸 )组 (A组 ) ,:入院当天常规给予氨甲苯酸 0 2g ,每日 2次静脉滴注 ,持续 14d。氨甲苯酸 +尼莫地平(尼莫通 )组 (B组 ) :氨甲苯酸 0 2g ,每日 2次静脉滴注 ,持续 14d ;尼莫地平 10mg·d-1,持续微量泵静脉滴注 ,每天 1次 ,共 14d。尼莫地平组 (C组 ) :尼莫地平 10mg·d-1持续微量泵静脉滴注 ,每天 1次 ,共 14d。将每组进一步按年龄区分为老年患者和中青年患者 ,进行治疗效果分析。结果 :A、B、C 3组脑缺血的发生率分别为 40 %、3 5 %和 2 0 % ,再出血发生率分别为 2 0 %、2 2 5 %和 3 0 % ,总的预后不良发生率为 45 %、3 2 5 %和 40 % ,以B组预后为最佳。 >65岁的老年人 ,止血剂治疗后脑缺血的发生率高达 60 %、不良预后占 61% ,明显高于不用止血剂治疗的SAH患者。结论 :单纯止血治疗不能改善SAH病人预后 ,加用钙拮抗剂可使不良预后发生率减少。对老年SAH患者 ,抗纤溶治疗可明显增加脑缺血和不良预后的发生率。
Objective: To investigate the anti-fibrinolytic agents and calcium antagonists in the treatment of patients with spontaneous subarachnoid hemorrhage (SAH). Methods: A total of 120 SAH patients were evaluated for their condition and randomly assigned to receive methotrexate (group A). On the day of admission, they were routinely given 0.2 g of methotrexate and intravenously twice daily 14d. Aminotoluene + nimodipine group (group B): ammonia toluen 0 2g twice daily intravenous infusion for 14 days; nimodipine 10mg · d-1, continuous micro-pump intravenous infusion , 1 day, a total of 14d. Nimodipine group (C group): nimodipine 10mg · d-1 continuous intravenous infusion of micro-pump once a day for 14 days. Each group was further divided into elderly patients and middle-aged patients by age, the treatment effect analysis. Results: The incidences of cerebral ischemia in group A, B and C were 40%, 35% and 20% respectively, and the rates of rebleeding were 20%, 25% and 30% respectively. The overall prognosis The incidence of adverse reactions was 45%, 35 2% and 40%, respectively. The best prognosis was in group B. > 65-year-olds, hemorrhagic agents after treatment of cerebral ischemia incidence of up to 60%, 61% of poor prognosis, was significantly higher than without SAH treatment of patients with hemostasis. Conclusion: Hemostasis alone can not improve the prognosis of patients with SAH, add calcium antagonists can reduce the incidence of adverse prognosis. For elderly patients with SAH, antifibrinolytic therapy can significantly increase the incidence of cerebral ischemia and adverse prognosis.