A cohort study of the safety and feasibility of intraventricular urokinase for nonaneurysmal spontaneous intraventricular hemorrhage
A cohort study of the safety and feasibility of intraventricular urokinase for nonaneurysmal spontaneous intraventricular hemorrhage
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DOI：
10.1161/01.str.29.8.1573
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发表时间：
1998-08-01
期刊：
影响因子：
8.3
通讯作者：
Muizelaar, JP
中科院分区：
文献类型：
--
作者：
Coplin, WM;Vinas, FC;Muizelaar, JP
背景和目的——小病例系列报道了自发性脑室内出血（IVH）后溶栓治疗的潜在益处。我们的目的是回顾我们使用脑室内尿激酶 (UK) 治疗选定的 IVH 患者的经验。方法 - 使用医疗记录，我们确定了从 1992 年 12 月到 1996 年 11 月因 CT 确诊的非动脉瘤性非创伤性自发性 IVH 接受脑室造口术的所有患者。我们回顾了图表和 CT 图像，并检查了数据与特定结果的关联。结果 - 我们确定了 40 名患者，其中 18 名接受了脑室造口术治疗单独治疗和 22 名接受辅助脑室内治疗。两组初始格拉斯哥昏迷量表（GCS）评分相似（P=0.5）。虽然存在脑实质内出血 (IPH) 患者接受 UK 治疗的趋势 (P=0.07)，但仅接受脑室造口术的患者 IPH 的平均大小大于接受辅助 UK 治疗的患者 (P=0.002)。 UK治疗组的死亡率较低（31.8% vs 66.7%；P=0.03），但有利结果仅呈增加趋势（22.2% vs 36.4%；P=0.3）。总体而言，与结果最显着的关联是就诊时的神经系统状况（GCS > 5 与小于或等于 5；P=0.003）。接受 UK 并未增加幸存者并发症的发生率或住院时间（P=0.5）。结论 - 脑室内 UK 仍然是一种安全且可能有益的干预措施。虽然它似乎可以降低死亡率，但仍需要一项随机、安慰剂对照试验来探讨该疗法是否可以增加有利结果的发生率。
Background and Purpose-Small case series have reported potential benefit from thrombolysis after spontaneous intraventricular hemorrhage (IVH). Our objective was to review our experience using intraventricular urokinase (UK) in treating selected patients with IVH.Methods-Using medical records, we identified all patients who received ventriculostomies for CT-confirmed nonaneurysmal nontraumatic spontaneous IVH from December 1992 through November 1996. We reviewed charts and CT images and examined the data for associations with specific outcomes.Results-We identified 40 patients, 18 treated with ventriculostomy alone and 22 receiving adjunctive intraventricular UK. The initial Glasgow Coma Scale (GCS) scores of the two groups were similar (P=0.5). While there was a trend for patients with any intraparenchymal hemorrhage (IPH) to receive UK (P=0.07), the mean size of IPH in those who received ventriculostomy alone was larger than in those who received adjunctive UK (P=0.002). There was lower mortality in the group treated with UK (31.8 versus 66.7%; P=0.03), but there was only a trend toward an increase in favorable outcome (22.2% versus 36.4%; P=0.3). Overall, the most significant association with outcome was neurological condition at presentation (GCS >5 versus less than or equal to 5; P=0.003). Receiving UK did not increase the occurrence of complications or hospital length of stay for survivors (P=0.5).Conclusions-Intraventricular UK remains a safe and potentially beneficial intervention. While it appeared to lower mortality, a randomized, placebo-controlled trial is needed to explore whether the therapy can increase the incidence of favorable outcomes.