蛛网膜下腔出血合并心脏病变的临床较多见;合并心脏病变,且有急性肾功衰竭,在我院神经内科还是首例,现报告如下。患者男性,65岁,汉族。7天前双下肢疼痛,逐渐波及腰部,最后两天出现剧烈头痛,伴有恶心呕吐于10—05—03急诊入院。否认外伤史。查体:神志清,血压27.3/16kPa,脉搏58次/分,体温36.2℃,呼吸20次/分. 心肺(-),肝脾(-),十二对颅神经正常。眼底Ⅱ级动脉硬化,无出血点。双掌颏反射(+),双巴氏征(+),颈强(++),克氏征(+),腰穿均匀一致血性脑脊液,颅内压2.4/kPa,血尿及血生化检查正常。心电:窦性心动过缓及T波改变。CT正常。诊断:蛛网膜下腔出血。临床常规应用20％甘露醇250ml+止血芳酸200mg,每6h一次静点。因病人能进半流食;故每天只补给生理量的液体及离子。5 Subarachnoid hemorrhage with heart disease clinical more common; combined with heart disease, and acute renal failure, in our hospital neurology is the first case, are as follows. Male patient, 65 years old, Han nationality. 7 days ago, both lower extremity pain, gradually spread to the waist, the last two days of severe headache, accompanied by nausea and vomiting in 10-05-03 emergency admission. Denied the history of trauma. Examination: conscious mind, blood pressure 27.3 / 16kPa, pulse 58 beats / min, body temperature 36.2 ℃, breathing 20 beats / min. Cardiopulmonary (-), liver and spleen (-), twelve pairs of cranial nerves normal. Fundus Ⅱ level arteriosclerosis, no bleeding point. Palate chin reflex (+), double Pakistan’s sign (+), neck strength (++), Krypton’s sign (+), waist wear uniform bloody cerebrospinal fluid, intracranial pressure 2.4 / kPa, hematuria and blood biochemical tests were normal . ECG: sinus bradycardia and T wave changes. CT is normal. Diagnosis: Subarachnoid hemorrhage. Clinical routine application of 20% mannitol 250ml + hemostatic aromatic acid 200mg, once every 6h static point. Due to the patient into the semi-liquid food, so only a day to supply the amount of fluid and plasma. 5