Cisternal irrigation therapy with urokinase and ascorbic acid for prevention of vasospasm after aneurysmal subarachnoid hemorrhage outcome in 217 patients
Cisternal irrigation therapy with urokinase and ascorbic acid for prevention of vasospasm after aneurysmal subarachnoid hemorrhage outcome in 217 patients
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DOI：
10.1016/s0090-3019(99)00183-4
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发表时间：
2000-02-01
影响因子：
--
通讯作者：
Asari, J
中科院分区：
文献类型：
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作者：
Kodama, N;Sasaki, T;Asari, J
尿激酶和抗坏血酸的脑池灌洗疗法被引入以预防蛛网膜下腔出血（SAH）后的症状性血管痉挛。为了溶解和冲洗蛛网膜下腔血块，使用尿激酶进行脑池冲洗。抗坏血酸可使氧合血红蛋白（最强的致痉挛物质之一）变性为非致痉挛的类绿血红素产物。方法对217例患者连续应用该疗法治疗，观察其疗效和安全性。患者的SAH程度被归类为Fisher CT第3组，SAH的最高CT值（Hounsfield值）超过60，这表明出现症状性血管痉挛的风险很大。所有患者均在SAH发作后72小时内接受手术。夹闭动脉瘤后，将冲洗管放置在单侧或双侧的侧裂（入口）和桥脑前池或视交叉池（出口）。含尿激酶（120 IU/mL）和抗坏血酸（4 mg/mL）的乳酸林格氏液以30 mL/小时/侧的速率输注约10 days。在研究的217例患者中，6例（2.8%）观察到症状性血管痉挛，其中2例（0.9%）显示后遗症。根据引流液计算的平均总血量约为114 mL。引流液的吸收光谱分析显示氧合血红蛋白特异性576 nm峰消失。8例患者在灌注治疗期间发生并发症; 2例患者发生癫痫发作，2例患者发生脑膜炎，4例患者发生颅内出血。然而，所有这些患者恢复无神经defictions.CONCLUSIONSThese结果表明，脑池冲洗治疗尿激酶和抗坏血酸是有效的，在预防症状性脑血管痉挛后蛛网膜下腔出血。(C)2000年，Elsevier Science Inc.
BACKGROUNDCisternal irrigation therapy with urokinase and ascorbic acid was introduced to prevent symptomatic vasospasm after aneurysmal subarachnoid hemorrhage (SAH). To dissolve and wash out the subarachnoid clot, cisternal irrigation with urokinase is used. Ascorbic acid is added to degenerate oxy-hemoglobin, one of the strongest spasmogenic substances, into verdohemelike products, which are nonspasmogenic. The efficacy and safety of this therapy were evaluated.METHODSThis therapy was performed consecutively in 217 patients. The degree of SAH of the patients was classified as Fisher CT Group 3, and the highest CT number (Hounsfield number) exceeded 60 in the SAH, which suggested a significant risk for symptomatic vasospasm. All patients underwent surgery within 72 hours from the onset of SAH. After clipping the aneurysm, irrigation tubes were placed in the Sylvian fissure (inlet) unilaterally or bilaterally and in the prepontine or chiasmal cistern (outlet). Lactated Ringer's solution with urokinase (120 IU/mL)and ascorbic acid (4 mg/mL) was infused at a rate of 30 mL/hour/side for approximately 10 days.RESULTSOf the 217 patients studied, symptomatic vasospasm was observed in 6 cases (2.8%), and two of these six cases (0.9%) demonstrated sequelae. The average total blood volume calculated from the drainage fluid was approximately 114 mL. Analysis of the absorption spectrum of the drainage fluid revealed disappearance of the oxy-hemoglobin-specific 576-nm peak. Complications occurred in eight patients during irrigation therapy; two patients experienced seizures, two patients developed meningitis, and four patients had an intracranial hemorrhage. However, all of these patients recovered without neurological deficits.CONCLUSIONSThese results suggest that cisternal irrigation therapy with urokinase and ascorbic acid is effective in preventing symptomatic vasospasm after aneurysmal SAH. (C) 2000 by Elsevier Science Inc.