蛛蜘網膜下腔出血中西醫治療病例

Management of subarachnoid hemorrhage by integrated Chinese and Western Medicine：a case report

每年在美國有四萬人因蜘蛛網膜下腔出血導致神經系統突然發生的大傷害，同時也導致身體功能喪失與高死亡率。會影響蜘蛛網膜下腔出血預後最重要的因素為因為血管痙攣而產生的腦部缺血。研究也指出腦部血管痙攣會減少腦部血流量。這位75歲男性病患為大量蜘蛛網膜下腔出血的患者，昏迷指數為E1VeM2，電腦斷層出現後顱窩有大量的蜘蛛網膜下腔出血合併腦幹與小腦處有腫塊效應，腦幹區域有明顯的血液灌流減少及腦室內出血併發阻塞性水腦；在緊急手術置入顱內壓力監測器與腦室外引流管以降低腦內壓力，但是病患手術後11天仍處於深度昏迷，因此家屬要求會診中醫治療，在使用中醫治療第3天時，病患的反應進步，在1個月後出院，因此我們提出此病例報告，希望可提供中西醫治療蜘蛛網膜下腔出血病例的經驗。

Subarachnoid hemorrhage (SAH) is a neurologic catastrophe, affecting approximately 40,000 patients yearly in the United States. Subarachnoid hemorrhage(SAH) is a potentially disastrous illness that leads to severe disability and a high mortality rate(1).One of the most important determinants of outcome after SAH is delayed cerebral ischemia from vasospasm (2–5). Studies of cerebral blood flow (CBF) showed that cerebral vasospasm is associated with reduced CBF (6–9). This is a case of 75 years old male patient with massive Subarachnoid hemorrhage (SAH).He suffered from coma with Glasgow Coma Scale revealed E1VeM2.The Brain Computered Tomography showed Massive SAH in posterior cranial fossa with mass effect to cerebellum and brain stem, and mark decreased attenuation of brain stem as mark vessel spasm of perforating artery and regurgitated blood into ventricular system resulting in obstructed hydrocephalus. After the emergent implanted the intracranial pressure monitor and external ventricular drainage for decreasing the intracranial pressure，the patient was still in deep comatose status after 11days.So the family asked for the combined treatment of Chinese Medicine. After the three day of Chinese medicine treatment, the patient had the better clinical response and was discharged one month later. So we reported the case for more experience about management of subarachnoid hemorrhage by integrated Chinese and Western Medicine.