Intensive Care Unit, Department of Neurology, Clinical Hospital Centre Rijeka, Croatia.
Acta Neurol Scand. 2011 Nov;124(5):343-8. doi: 10.1111/j.1600-0404.2010.01481.x. Epub 2011 Feb 8.
To evaluate safety, clinical feasibility, and outcome of intraventricular (IVen) administration of recombinant tissue plasminogen activator (rt-PA) in patients with intraventricular hemorrhage (IVH).
Forty-eight patients with IVH who received IVen rt-PA were compared with 49 age-, sex-, Glasgow Coma Scale score-, and Intracerebral Hemorrhage score-matched control patients. Patients with IVH of aneurysmal or arteriovenous malformation origin were excluded. External ventricular drainage was inserted as soon as baseline CT was performed and rt-PA was administered within 12 ± 1 h after the ictal onset.
The outcome after 3 months was evaluated using the modified Rankin Scale (mRS). In addition, Glasgow Outcome Scale (GOS) and mortality were assessed. A good outcome, defined as mRS 0-3, was detected in 27% of patients from the control group vs 58% of patients in the IVen group; P = 0.003. GOS as other outcome scale yielded a significant difference between groups: 20% in the control group, vs 54% in the IVen group; P = 0.001. A statistically significant decrease in mortality was observed in the IVen group: 30% in the control vs 10% in IVen group; P = 0.003. No one patient died because of a complication which could be directly attributed to the IVen thrombolytic therapy.
IVen administration of rt-PA seems to be safe in cases of IVH. This pilot study shows that it may be associated with better outcomes. Further studies and clinical randomized trials are needed to establish indications and IVen administration protocols.
评估脑室（IVen）内给予重组组织型纤溶酶原激活剂（rt-PA）治疗脑室内出血（IVH）患者的安全性、临床可行性和结局。
将 48 例接受 IVen rt-PA 治疗的 IVH 患者与 49 例年龄、性别、格拉斯哥昏迷评分和脑出血评分匹配的对照组患者进行比较。排除 IVH 为动脉瘤或动静脉畸形起源的患者。基线 CT 检查后立即插入外部脑室引流管，并在发作后 12±1 小时内给予 rt-PA。
采用改良 Rankin 量表（mRS）评估 3 个月后的结局。此外，评估格拉斯哥预后量表（GOS）和死亡率。对照组中良好结局（mRS 0-3）的患者占 27%，IVen 组为 58%；P=0.003。作为其他结局评估量表的 GOS 在两组之间存在显著差异：对照组为 20%，IVen 组为 54%；P=0.001。IVen 组死亡率显著下降：对照组为 30%，IVen 组为 10%；P=0.003。无一例患者因可直接归因于 IVen 溶栓治疗的并发症而死亡。
IVen 给予 rt-PA 治疗 IVH 似乎是安全的。这项初步研究表明，它可能与更好的结局相关。需要进一步的研究和临床随机试验来确定适应证和 IVen 给药方案。
