Cohort study of intraventricular thrombolysis with recombinant tissue plasminogen activator for aneurysmal intraventricular hemorrhage
Cohort study of intraventricular thrombolysis with recombinant tissue plasminogen activator for aneurysmal intraventricular hemorrhage
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DOI：
10.1227/01.neu.0000134473.98192.b1
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发表时间：
2004-09-01
期刊：
影响因子：
4.8
通讯作者：
Jacka, MJ
中科院分区：
文献类型：
--
作者：
Findlay, JM;Jacka, MJ
目的：通过脑室外引流给予溶栓药物治疗脑室内出血，目的是加速血栓清除，防止导管阻塞，帮助控制颅内压。我们比较了一组动脉瘤患者的这些变量，一名外科医生常规使用脑室重组组织纤溶酶原激活剂（rt-PA）治疗梗阻性脑出血，而另一组类似的患者则由其他外科医生不使用。方法：纳入本分析的患者是那些修复的脑动脉瘤导致至少三个脑室出血，脑室肿大，需要脑室外引流的患者。当所有心室在计算机断层扫描上均未闭合且体积减小时，认为心室系统“打开”。那些接受rt-PA治疗的患者通过心室引流每天给予4mg，直到心室打开。结果：21例接受rt-PA治疗的患者至心室开放的平均天数为3.9天（标准差[SDI， 1.0）， 9例未接受rt-PA治疗的患者至心室开放的平均天数为7.1天（SD, 3.7） （P = 0.001），在同一时间间隔内，未接受rt-PA治疗组的平均颅内压（mm Hg）为10.4天（SD, 6.1），而未接受rt-PA治疗组的平均颅内压（mm Hg）为14.1天（SD, 5.9） （P = 0.13）。1例rt-PA患者（在rt-PA治疗前导管放错）和3例未接受rt-PA治疗的患者（均为导管阻塞伴血凝块）需要置换术（P = 0.07）， 4例rt-PA患者和3例未接受rt-PA治疗的患者（P = 0.4）放置了脑室-腹膜分流器。结论：rt-PA脑室溶栓似乎有助于急性处理大动脉瘤性脑室内出血患者，加速动脉瘤性脑室内出血的清除，使颅内压正常化，减少脑室导管阻塞。需要一项随机试验来证实这些发现，确定治疗的安全性，并确定治疗是否影响结果。
OBJECTIVE: Thrombolytic agents have been administered through external ventricular drains to treat intraventricular hemorrhage, the goals being to accelerate clot clearance, prevent catheter obstruction, and help control intracranial pressure. We compared these variables in a group of aneurysm patients treated by one surgeon who routinely used intraventricular recombinant tissue plasminogen activator (rt-PA) for obstructive hematocephalus with those in a group of similar patients treated by other surgeons who did not.METHODS: Patients included in this analysis were those with repaired cerebral aneurysms causing hemorrhage into at least three ventricles with ventriculomegaly requiring external ventricular drainage. The ventricular system was considered "opened" when all ventricles were patent and reduced in size on computed tomographic scans. Those treated with rt-PA received 4 mg/d through a ventricular drain until ventricular opening.RESULTS: The mean number of days to ventricular opening was 3.9 (standard deviation [SDI, 1.0) for the 21 patients treated with rt-PA and 7.1 (SD, 3.7) for the 9 who were not (P = 0.001), and the mean intracranial pressure (mm Hg) 24 hours after treatment with rt-PA was 10.4 (SD, 6.1) compared with 14.1 (SD, 5.9) during the same interval for the group that did not receive rt-PA (P = 0.13). Ventricular catheter replacement was required in 1 rt-PA patient (for a misplaced catheter, before rt-PA treatment) and 3 patients who did not receive rt-PA (all for catheter obstructions with blood clot) (P = 0.07), and ventriculoperitoneal shunts were placed in 4 rt-PA patients and 3 patients who did not receive rt-PA (P = 0.4).CONCLUSION: Intraventricular thrombolysis with rt-PA seems to assist in the acute management of patients with large aneurysmal intraventricular hemorrhages, speeding clearance of aneurysmal intraventricular hemorrhage, normalizing intracranial pressure, and reducing ventricular catheter obstruction. A randomized trial is needed to confirm these findings, establish treatment safety, and determine whether treatment affects outcome.