No exacerbation of perihematomal edema with intraclot urokinase in patients with spontaneous intracerebral hemorrhage
No exacerbation of perihematomal edema with intraclot urokinase in patients with spontaneous intracerebral hemorrhage
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DOI：
10.1007/s00701-014-2130-9
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发表时间：
2014-09-01
影响因子：
2.4
通讯作者：
Zhu, Suiqiang
中科院分区：
文献类型：
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作者：
Lian, Lifei;Xu, Feng;Zhu, Suiqiang
自发性脑出血(ICH)后，血肿周围水肿(Phe)会加重患者的预后。微创手术结合血肿溶栓治疗已被证明是一种很有前途的治疗策略。然而，临床前研究表明，脑出血后溶栓治疗可能会加重PHE。在此，我们调查了脑出血患者接受脑脊液和尿激活剂治疗的效果。使用CT扫描T-1(管理信息系统前)和T-2(管理信息系统后)时间点，应用计算机化的容量分析来评估脑出血和脑出血体积的变化。以Phe与T-1脑出血体积之比计算相对Phe(RPhe)，分析60例脑出血患者(MISU组)、20例单纯MIS术(MO组)和30例对照组患者的数据。脑出血体积，脑出血体积，Phe体积，T-2CT上Phe体积，13.7+/-5.7ml，17.0+/-10.5mlvs.30.5+/-10.3ml，P<；0.01；Phe体积，36.5+/-18.9ml，32.2+/-17.5mlvs.45.4+/-16.0ml，P<；RPhe，0.9+/-0.4，0.8+/-0.4对1.4+/-0.5，P<；0.01)。在MI+U组和MO组之间，脑出血体积、Phe体积和T-2时的rPhe趋于相似，但差异无统计学意义(P=0.09，P=0.40，P=0.43)。此外，我们还发现脑出血清除率与Phe减少之间存在显著的相关性(r=0.59，P<；0.01)。尿激酶累积剂量与T-2Phe体积(r=0.19；P=0.16)或T-2rPhe(r=-0.12；P=0.37)均无相关性。此外，尿激酶的使用不会加重Phe，当直接将溶栓剂注射到血栓中时，不太可能产生假想的水肿性作用。
Perihematomal edema (PHE) can worsen patient outcomes after spontaneous intracerebral hemorrhage (ICH). Minimally invasive surgery (MIS) in combination with thrombolytic removal of hematoma has been proven to be a promising treatment strategy. However, preclinical studies have suggested that intraclot thrombolysis may exacerbate PHE after ICH. Herein, we investigated the effects of MIS and urokinase on PHE.ICH patients were retrospectively identified from our institutional ICH database. Computerized volumetric analysis was applied to assess changes in both ICH and PHE volumes using computed tomographic (CT) scans of T-1 (pre-MIS) and T-2 (post-MIS) time points. Relative PHE (rPHE) was calculated as a ratio of PHE and T-1 ICH volume.Data from 60 MIS plus urokinase (MIS + U), 20 MIS aspiration only (MO), and 30 control patients were analyzed. The ICH volume, PHE volume and rPHE on T-2 CT in both MIS + U and MO groups significantly decreased as compared with the control group (ICH volume, 13.7 +/- 5.7 ml, 17.0 +/- 10.5 ml vs. 30.5 +/- 10.3 ml, P < 0.01; PHE volume, 36.5 +/- 18.9 ml, 32.2 +/- 17.5 ml vs. 45.4 +/- 16.0 ml, P < 0.01; rPHE, 0.9 +/- 0.4, 0.8 +/- 0.4 vs.1.4 +/- 0.5, P < 0.01). Between the MIS + U and MO groups, the ICH volume, PHE volume and rPHE at T-2 trended towards similarity, but was not significant (P = 0.09, P = 0.40, P = 0.43). Furthermore, we found a significant correlation between the percent of ICH removal and PHE reduction (r = 0.59, P < 0.01). There was no correlation between the cumulative dose of urokinase and either T-2 PHE volume (r = 0.19; P = 0.16) or T-2 rPHE (r = -0.12; P = 0.37).Hematoma evacuation using MIS leads to a significant reduction in PHE. Furthermore, the use of urokinase does not exacerbate PHE, making its hypothesized proedematous effects unlikely when the thrombolytic is administered directly into the clot.