Fountas K N, Kapsalaki E Z, Parish D C, Smith B, Smisson H F, Johnston K W, Robinson J S
Department of Neurosurgery, The Medical Center of Central Georgia, Mercer University, School of Medicine, Macon, GA, USA.
South Med J. 2005 Aug;98(8):767-73. doi: 10.1097/01.smj.0000170732.24324.ea.
Intraventricular hemorrhage (IVH) represents a clinicopathologic entity with a dismal prognosis. The associated mortality rate has been reported as high as 80%; the morbidity is also quite high. The use of various fibrinolytic agents (streptokinase, urokinase, and recombinant tissue-type plasminogen activator [rt-PA]) has been reported in a small number of clinical series with a very limited number of participants, yielding significant variability regarding inclusion criteria, treatment protocol, and outcome analysis.
In our prospective study, we report our experience using rt-PA in 21 patients with IVH. Patients with IVH of aneurysmal or arteriovenous malformation origin were excluded. Intraventricular administration of rt-PA was initiated within 24 hours after the ictal event (dose, 3 mg every 24 hours) through a ventricular catheter. The patients' intracranial and cerebral perfusion pressures, cerebrospinal fluid (CSF) cell count, and head CT scans with emphasis to frontal horn dimension and inner cranium diameter at the same level ratio were collected and analyzed.
Good outcome was observed in 47.5% of our patients, whereas 28.5% died and 24.0% survived with severe disability. The development of rt-PA-associated complications was as follows: new hemorrhage in 19%, infection in 14.3%, and CSF pleocytosis in 100% of patients. Permanent CSF shunt was required in 40%. The intermediate (3-month) follow up of our survivors showed no significant outcome changes compared with the immediate (1-month) follow up.
Intraventricular administration of rt-PA appears to be beneficial in cases of IVH even though it is occasionally associated with serious complications. Further multi-institutional studies are required for validating this treatment modality and standardizing its parameters.
脑室内出血（IVH）是一种临床病理实体，预后不佳。据报道，其相关死亡率高达80%；发病率也相当高。在少数临床系列研究中报道了使用各种纤维蛋白溶解剂（链激酶、尿激酶和重组组织型纤溶酶原激活剂[rt-PA]），但参与者数量非常有限，在纳入标准、治疗方案和结果分析方面存在显著差异。
在我们的前瞻性研究中，我们报告了在21例IVH患者中使用rt-PA的经验。排除动脉瘤或动静脉畸形所致IVH患者。在发作事件后24小时内通过脑室导管开始脑室内给予rt-PA（剂量为每24小时3mg）。收集并分析患者的颅内和脑灌注压、脑脊液（CSF）细胞计数以及头部CT扫描，重点关注额角尺寸和同一水平颅骨内直径比值。
我们的患者中有47.5%获得了良好的结果，而28.5%死亡，24.0%存活但有严重残疾。rt-PA相关并发症的发生情况如下：19%出现新的出血，14.3%发生感染，100%的患者出现脑脊液细胞增多。40%的患者需要永久性脑脊液分流。我们的幸存者在中期（3个月）随访时与即时（1个月）随访相比，结果无显著变化。
脑室内给予rt-PA在IVH病例中似乎是有益的，尽管它偶尔会伴有严重并发症。需要进一步的多机构研究来验证这种治疗方式并规范其参数。
