重组组织型纤溶酶原激活剂治疗脑室内出血

目的 探讨利用重组组织型纤溶酶原激活剂(rt-PA)脑室内给药治疗脑室出血的疗效和安全性. 方法 对自2005年11月至2007年10月收入我院的10例脑室出血患者CT确诊后,进行(单侧或双侧)脑室穿刺置管,4～6 h后经弓l流管缓慢注入rt-PA 4～8 mg,12～24 h重复1次,每24～48小时复查CT了解脑室内血肿清除情况,直至头颅CT扫描显示脑室内高密度影像消失.于脑室出血后30 d时对患者情况利用GOS评分进行评估. 结果 每个患者应用rt-PA总剂量为13～24 mg,30 d后GOS评分为良好4例,中残3例,重残2例,植物生存1例,无患者死亡,无出血、颅内感染等并发症,未发生引流管被血块堵塞情况. 结论 选择适宜剂量和方法的rt-PA脑室内给药能够加速脑室内血块溶解,保持脑室引流管通畅,减少血块占位效应.该方法能够安全有效地改善患者的预后.

Treatment of intraventricular hemorrhage with recombinant tissue plasminogen activator

Objective To study the clinical efficacy and safety of direct intraventricular administration of recombinant tissue plasminogen activator (rt-PA) in patients with intraventricular hemorrhage (IVH). Methods A series of 10 patients with IVH, admitted to our hospital from November 2005 to October 2007, was studied for the effect of direct intraventricular administration of rt-PA. In all patients, ventriculostomy was performed in unilateral or bilateral ventricles through frontal burr holes as soon as the IVH was diagnosed on CT. Four or 6 h later, 4 to 8 mg rt-PA was slowly injected through the ventricular catheter. The injection was repeated at 12-24 h intervals until serial CT scans showed a substantial reduction of intraventricular blood. CT scan was conducted at 24-48 h after injection of rt-PA. The outcome of patients was evaluated according to Glasgow Outcome Scale (GOS)on day 30 after IVH. Results The total dose of rt-PA per patient ranged from 13 to 24 mg. On day 30after IVH, 4 patients had a good recovery, 3 patients were moderately disabled, 2 were severely disabled,and 1 was in a vegetative state, and no patient died. There were no hemorrhagic and intracranial infectious complications resulted from treatment, and no catheter became obstructed With blood clot.Conclusions Intraventricular administration of rt-PA can speed the resolution of intraventricular blood clot, keep the ventricular drainage catheter open, reduce the space-occupying effect of the blood clot.Intraventricular administration ofrt-PA is effective and safe, and can improve the patients' prognosis.