The translation of the provided text is extensive and complex due to its medical nature and some unclear expressions. Below is a structured and coherent translation:
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**Treatment Experience in 48 Cases of Subarachnoid Hemorrhage in the Elderly**
**Results:**
Among 48 cases, 26 were general workers, 10 were mental laborers, 8 were primarily housewives, and 4 were heavy manual laborers. The history of hypertension was found in 20 cases, coronary heart disease in 6 cases, hyperlipidemia in 6 patients, diabetes in 6 patients, and ignorance of any disease in 12 cases.
Clinical manifestations included: acute onset in 42 cases, gradual progression in 6 cases. The first symptoms reported were severe headache in 32 cases, dizziness in 28 cases, vomiting in 24 cases, psychiatric disorders in 4 cases, coma in 4 cases, and convulsions in 4 cases. Consciousness disorders occurred in 16 cases (8 cases with eosinophilic changes, 4 cases with confusion, and 4 cases with coma). Neck resistance was present in 32 cases, hemiplegia in 6 cases, monoplegia in 1 case, and Klinefelter syndrome positivity in 24 cases. Positive PAP syndrome was observed in 6 cases.
Auxiliary examinations: CST examination was conducted in 38 cases, with red blood cell count >100×10^9/L in 38 cases and <10×10^9/L in 6 cases. Cranial CT scans indicated subarachnoid hemorrhage (SAH). Elevated blood urea nitrogen levels (10-26 mmol/L) were noted in 18 cases, low blood potassium (2.5-3 mmol/L) in 2 cases, low blood sodium (126 mmol/L) in 1 case, and high blood sugar (8-15 mmol/L) in 4 cases. Electrocardiographic abnormalities were observed in 11 cases, including ischemic changes in 3 patients, sinus bradycardia in 3 patients, and premature ventricular contractions in 3 patients. Pulmonary infection occurred in 4 cases, urinary tract infection in 4 cases, and rebleeding in 5 cases. Emotional rest was poor in 1 patient, and defecation-related complications occurred in another.
**Treatment and Outcome:**
Treatment involved intravenous infusion of 0.5g fibrinolytic aromatic acid + 500ml glucose daily for 3 weeks. Intravenous administration of Gan eel ace J25~25"1Ell static Li was given every 4-6 hours. Nimodipine (Q~30mg, three times daily) was used to prevent cerebral vasospasm. Phenobarbital sodium (4-8mg/kg, twice daily) was administered intramuscularly for mental symptoms, with improvement typically seen within 5-7 days. Broad-spectrum antibiotics were used to treat infections and complications actively. Hospital stay ranged from 1 to 7 weeks, averaging 32 days. No cases experienced cerebral vasospasm or secondary cerebral infarction. Clinical cure was achieved in 32 cases (66.7%), improvement in 12 cases (25%), and death in 4 cases (8.3%). Among the deaths, 3 were due to rebleeding, and 1 was due to brain cancer.
**Discussion:**
This study reports on 48 cases of ISAH, with a total effective rate of 91.7% and a mortality rate of 8.3%. Key experiences include:
1. **Preventing Rebleeding:** Plasmin inhibitors are generally used to prevent rebleeding, with fibrinolytic agents as the mainstay. Common doses involve 0.5g fibrinolytic aromatic acid dissolved in 5% glucose (500ml), administered intravenously. However, large doses may induce cerebral thrombosis, requiring caution.
2. **Reducing Intracranial Pressure:** Active treatment of intracranial hypertension is essential. Mannitol (20%, 125ml) was administered intravenously every 6 hours, effectively reducing intracranial pressure.
3. **Preventing Cerebral Vasospasm:** Nimodipine (30mg, three times daily) was used to prevent cerebral vasospasm-induced infarction, with no such cases observed.
4. **Managing Complications:** Elderly patients are prone to immunocompromised states and renal dysfunction. Prolonged bed rest and dehydration therapy increase the risk of infections and electrolyte imbalances, especially in comatose patients. Monitoring serum electrolytes and adjusting treatments accordingly is crucial.
5. **Blood Pressure Management:** Sustained hypertension should be controlled appropriately, avoiding excessive reduction below 200mmHg. Nifedipine (10mg, three times daily) was used to prevent rebleeding, emphasizing absolute bed rest and emotional stability.
**References:**
1. Science Journal, 1993, Vol. 9(5): 552.
2. Dai Ziying, ed. *Practical Medicine: Subarachnoid Hemorrhage*.
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