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患者女性,65岁。因头痛14小时,呕吐4次于1989年6月14日以蛛网膜下腔出血入院。体检:T37.2℃,BP21.3/13.3kPa,神志清,痛苦表情,查体合作。双侧瞳孔等大等圆,直径约2.5cm,光反射正常。颈部有抵抗感,四肢肌力正常,生理反射存在,病理反射未引出。腰穿脑脊液呈血性。 住院经过:入院后给予止血、脱水降颅压,肌注利血平0.5mg,每日2次以降压。入院后25小时病情突然加重,呈昏迷状态,双侧瞳孔缩小,约1.5cm,光反射存在。T39℃,四肢呈驰缓性瘫痪,肌力0级,腱反射消失。血压降至14.6/9.3kPa,停用利血平,考虑再出血,继续脱水治疗,15天后体温正常,呼吸平稳,瞳孔正常大小,眼球能转动,但无情感反应,存在失语与吞咽障碍,四肢对疼痛刺激无反应。纠正诊断:闭锁综合征。给予扩张血管,营养脑神经,鼻饲等综合治疗26天,病情无好转,自动出院。
Patient female, 65 years old. 14 hours due to headache, vomiting 4 times in June 14, 1989 to subarachnoid hemorrhage admission. Physical examination: T37.2 ℃, BP21.3 / 13.3kPa, clear mind, painful facial expression, physical examination cooperation. Big pupils and other round, diameter of about 2.5cm, normal light reflex. Neck resistance, normal limb muscle strength, the existence of physiological reflex, pathological reflex did not lead. Waist wear cerebrospinal fluid was bloody. After hospitalization: given to stop bleeding after admission, dehydration reduce intracranial pressure, intramuscular injection of reserpine 0.5mg, 2 times a day to step-down. 25 hours after admission, the condition suddenly aggravated, showing a coma, bilateral miosis, about 1.5cm, light reflex exists. T39 ℃, limbs were slow paralysis, muscle strength 0, tendon reflex disappeared. Blood pressure was reduced to 14.6 / 9.3kPa, reserpine was discontinued, consider rebleeding, continue dehydration treatment, normal body temperature after 15 days, stable breathing, pupil normal size, the eye can rotate, but no emotional reaction, the presence of aphasia and swallowing disorders, limbs No reaction to painful stimuli. Correct diagnosis: atresia syndrome. Given to the expansion of blood vessels, nutritional brain nerve, nasal feeding and other comprehensive treatment of 26 days, no improvement in condition, discharged automatically.