The treatment of subarachnoid hemorrhage (SAH) is divided into two types: surgical and medical. Surgical treatment is aimed at removing the cause of the disease, which is significant in stopping bleeding and preventing rebleeding.
Therefore, except for those who are in serious condition, too old or accompanied by other serious complications, surgical treatment should be carried out without loss of time, especially for those who have cerebral hemangiomas and vascular malformations, which are more necessary. However, in rural or remote mountainous areas, where surgery is not possible due to the limitations of medical technology and equipment, medical treatment is still very important.
(1) Absolute bed rest: Some data show that the recurrence rate and death rate of subarachnoid hemorrhage are very high in the first 2 to 4 weeks after the onset of hemorrhage, and the recurrence rate is greatly reduced in the 4 weeks after the onset of hemorrhage. All factors that can cause blood pressure rise, such as premature activity, emotional excitement, straining to defecate, coughing violently, etc., can lead to re-bleeding. Therefore, patients should be required to absolute bed rest, the time is generally not less than 1 month, and should pay attention to emotional control, to avoid emotional excitement and forceful defecation, minimize visits and conversation. For those who are conscious, give enough painkillers to control the headache.
For those who are agitated, sedatives such as diazepam 10mg, intramuscular injection can be used appropriately. To avoid urinary retention and constipation. Comatose patients retained catheter, flushing on time. Constipation, give laxatives and laxatives, such as foley catheterization, cecrops and so on.
(2) control blood pressure: elevated blood pressure is the main cause of subarachnoid rebleeding. Therefore, attention should be paid to control blood pressure. Generally, it should be kept at the usual level, preferably not more than 20/12kPa, but it can't be lowered too low to prevent insufficient cerebral blood supply. In the choice of drugs, in recent years, more advocate the use of calcium antagonists, such as nifedipine, nimodipine, nicardipine and other drugs.
These drugs can not only control blood pressure, but also through the blood-brain barrier, selective expansion of cerebral blood vessels, to relieve cerebral vasospasm.
(3) Reduce cerebral edema: after subarachnoid hemorrhage, cerebrospinal fluid is mixed with a large amount of blood, and even clots, which affects the circulation of cerebrospinal fluid and increases intracranial pressure, and the patients often show severe headache and consciousness disorder, etc., which should be actively treated. The general application of 20% mannitol 250ml plus dexamethasone 10mg, intravenous push or rapid drip, every 4 ~ 6 hours, once, if necessary, with tachycardia 20 ~ 40mg, intramuscular injection, but also can achieve better results.
(4) the application of hemostatic agents: 6-aminohexanoic acid, hemostatic aryllic acid is an antifibrinolytic drugs, can inhibit the activation factor of fibrinogen, so that the fibrinogen is not activated into fibrinolytic enzyme, thereby inhibiting the dissolution of fibrin, to protect the formation of vascular rupture of blood clots, in order to prevent re-bleeding. How to use: Add 6-aminohexanoic acid 6～12g with 5% sugar saline 500ml intravenously, once a day, can be used for 1～2 weeks. Hemostatic aphthous acid 200 ~ 400mg, plus 5% ~ 10% glucose 500ml intravenous drip, once a day, or 0.1 ~ 0.2g / times, slow static injection, 2 ~ 3 times a day. In addition, can also be used Anluo blood, hemostatic minerals, vitamin K and other drugs, but the efficacy is not certain.
(5) Lumbar puncture cerebrospinal fluid therapy: when the patient's severe headache is difficult to control with general painkillers, it is prudent to use lumbar puncture cerebrospinal fluid therapy to relieve the clinical symptoms.
But must pay attention to the following points: ① patients without brain hernia formation. ② The headache is severe, the painkillers are not effective, and there is no focal localization signs. ③ The lumbar puncture action should be gentle, and the speed of fluid release should be slow, in order to prevent the formation of cerebral hernia. ④ If the symptoms improve significantly after a small amount of cerebrospinal fluid is released, the procedure can be repeated every 4 to 5 days to accelerate the removal of blood from the subarachnoid space and reduce the occurrence of complications such as subarachnoid adhesions.