Varelas Panayiotis N, Rickert Kim L, Cusick Joseph, Hacein-Bey Lotfi, Sinson Grant, Torbey Michel, Spanaki Marianna, Gennarelli Thomas A
Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Neurosurgery. 2005 Feb;56(2):205-13; discussion 205-13. doi: 10.1227/01.neu.0000147973.83688.d8.
Intraventricular (IVen) hemorrhage is considered a predictor of poor outcome after subarachnoid hemorrhage (SAH). This prospective study examines the feasibility and outcome of administration of IVen tissue plasminogen activator (tPA) after aneurysmal SAH.
Ten patients with SAH who received IVen tPA after the aneurysm had been secured were compared with 10 age-, sex-, and Glasgow Coma Scale score-matched control patients. The primary end point was third and fourth ventricle clot resolution. IVen blood was quantified by use of the Graeb and Le Roux scales on admission and at an additional time (equal or longer for the control group) after the injection was terminated.
Six men and four women with a mean age of 52 years in each group were evaluated. On average, 3.5 mg tPA was injected 68 +/- 51 hours after admission without ensuing complications. Although the treated group had significantly more IVen blood on admission than control subjects (mean Le Roux scale +/- standard deviation, 11 +/- 3 versus 7.6 +/- 4.2, P = 0.055, and mean Graeb scale +/- standard deviation, 8.5 +/- 2.3 in tPA versus 5.3 +/- 3, P < 0.02), it also had a significant decrease in the amount of IVen blood (mean Le Roux and Graeb scale decrease +/- standard deviation, 6.7 +/- 3.3 and 4.8 +/- 2 in tPA patients versus 0.9 +/- 3.2 and 0.5 +/- 2.6 in control subjects, P = 0.002). The tPA group had a non-statistically significantly shorter length of stay, decreased mortality, and better Glasgow Outcome Scale and modified Rankin Scale scores at discharge. Treated survivors showed a decreased need for shunt placement (2 [22%] of 9 patients versus 5 [83%] of 6 control subjects, P = 0.04).
This pilot study shows that IVen tPA administration is feasible without complications after SAH and may be associated with better outcomes. These results warrant a randomized clinical trial.
脑室内出血被认为是蛛网膜下腔出血（SAH）后预后不良的一个预测指标。本前瞻性研究探讨了动脉瘤性SAH后给予脑室内组织型纤溶酶原激活剂（tPA）的可行性及疗效。
将10例动脉瘤夹闭术后接受脑室内tPA治疗的SAH患者与10例年龄、性别和格拉斯哥昏迷量表评分相匹配的对照患者进行比较。主要终点是第三和第四脑室血凝块溶解情况。在入院时以及注射结束后的另一个时间点（对照组时间相同或更长），使用格雷布（Graeb）和勒鲁（Le Roux）量表对脑室内血量进行量化。
每组评估了6名男性和4名女性，平均年龄52岁。平均在入院后68±51小时注射3.5mg tPA，未出现并发症。虽然治疗组入院时脑室内血量显著多于对照组（平均勒鲁量表±标准差，11±3对7.6±4.2，P = 0.055；平均格雷布量表±标准差，tPA组为8.5±2.3对对照组的5.3±3，P < 0.02），但其脑室内血量也显著减少（tPA组平均勒鲁和格雷布量表减少量±标准差，分别为6.7±3.3和4.8±2；对照组分别为0.9±3.2和0.5±2.6，P = 0.002）。tPA组住院时间非统计学显著缩短，死亡率降低，出院时格拉斯哥预后量表和改良Rankin量表评分更好。治疗后的幸存者分流置入需求减少（9例患者中有2例[22%]，而6例对照患者中有5例[83%]，P = 0.04）。
这项初步研究表明，SAH后脑室内给予tPA是可行的，且无并发症，可能与更好的预后相关。这些结果值得进行一项随机临床试验。
