蛛网膜下腔出血并发应激性溃疡的防治及护理  

Prevention and Care of Stress Ulcer Complicated by Subarachnoid Hemorrhage

作　　者：周婧 ZHOU Jing(Department of Neurosurgery,Tianjin Huanhu Hospital,Tianjin 300222,China)

机构地区：[1]天津市环湖医院神经外科,天津300222

出　　处：《继续医学教育》2024年第5期176-179,共4页Continuing Medical Education

摘　　要：蛛网膜下腔出血是临床常见的出血性脑血管疾病,分为自发性和外伤性2种情况,自发性蛛网膜下腔出血为脑底或脑表面血管破裂,血液进入蛛网膜下腔。患者起病急,致残率、死亡率高,早期往往并发再次出血、脑血管痉挛、急性脑积水、癫痫发作等。部分危重患者常伴有应激性消化道溃疡并出血,临床上普遍应用各种抑制胃酸制剂和去甲肾上腺素进行防治。对于应激性溃疡发病机制的认识由早期的胃酸分泌增多到胃肠黏膜屏障保护功能受损,现已延伸到了神经内分泌功能失调等综合因素的结果;治疗方面在积极处理原发病的基础上早期留置胃管、给予肠内营养、肠外营养、应用抑制胃酸剂、胃黏膜保护剂以及中医中药等综合治疗可更好地防治应激性上消化道溃疡出血。因此,如何观察和护理应激性溃疡的发生,对提高蛛网膜下腔出血患者的治愈率、挽救患者的生命起着十分重要的作用。Subarachnoid hemorrhage is a common hemorrhagic cerebrovascular disease in clinical practice,which can be divided into two types:spontaneous and traumatic.Spontaneous subarachnoid hemorrhage is the rupture of vascular lesions in the brain floor or surface,and blood enters the subarachnoid space.Patients with acute onset,high disability and mortality rates,often experience complications such as recurrent bleeding,cerebral vasospasm,acute hydrocephalus,and epileptic seizures in the early stages.Some critically ill patients often have stressinduced gastrointestinal ulcers and bleeding,and various gastric acid inhibitors and norepinephrine are commonly used in clinical practice for prevention and treatment.The understanding of the pathogenesis of stress ulcers has evolved from early increased gastric acid secretion to impaired protection of the gastrointestinal mucosal barrier,and has now extended to the result of comprehensive factors such as neuroendocrine dysfunction;in terms of treatment,early indwelling of gastric tubes,enteral and parenteral nutrition,application of gastric acid suppressants,gastric mucosal protectants,and comprehensive treatment with traditional Chinese medicine can better prevent and treat stress induced upper gastrointestinal ulcer bleeding on the basis of actively treating the underlying disease.Therefore,how to observe and care for the occurrence of stress ulcers plays a very important role in improving the cure rate of patients with subarachnoid hemorrhage and saving their lives.

关 键 词：蛛网膜下腔出血 应激性溃疡 消化道出血 营养支持 观察 护理 

分 类 号：R473[医药卫生—护理学]