Tsementzis S A, Honan W P, Nightingale S, Hitchcock E R, Meyer C H
Midland Centre for Neurosurgery and Neurology, Smethwick, Warley, U.K.
Acta Neurochir (Wien). 1990;103(3-4):116-21. doi: 10.1007/BF01407517.
Seventy-four patients with recent subarachnoid haemorrhage were randomly allocated to placebo or tranexamic acid treatment. Fibrinolytic activity in the blood and cerebrospinal fluid was assessed before treatment, one week later and two weeks later. The natural history of fibrinolysis following subarachnoid haemorrhage was obtained from analysis of the placebo group. Following subarachnoid haemorrhage, fibrin degradation products and plasminogen activity in the cerebrospinal fluid were elevated. Subsequently, fibrin degradation products in the cerebrospinal fluid fell progressively over the following 2 weeks. Changes in cerebrospinal fluid plasminogen activity correlated with those of blood plasminogen activity. Complications such as rebleeding, hydrocephalus or cerebral thrombosis could not be predicted from analysis of fibrinolytic activity. Tranexamic acid treatment resulted in a reduction in cerebrospinal fluid and blood plasminogen activity. The relevance of fibrinolysis in cerebrospinal fluid and blood to the management of subarachnoid haemorrhage is discussed.
74例近期发生蛛网膜下腔出血的患者被随机分配接受安慰剂或氨甲环酸治疗。在治疗前、治疗一周后和两周后评估血液和脑脊液中的纤溶活性。通过对安慰剂组的分析得出蛛网膜下腔出血后纤溶的自然病程。蛛网膜下腔出血后，脑脊液中的纤维蛋白降解产物和纤溶酶原活性升高。随后，脑脊液中的纤维蛋白降解产物在接下来的2周内逐渐下降。脑脊液纤溶酶原活性的变化与血液纤溶酶原活性的变化相关。通过纤溶活性分析无法预测再出血、脑积水或脑血栓形成等并发症。氨甲环酸治疗导致脑脊液和血液纤溶酶原活性降低。讨论了脑脊液和血液中的纤溶与蛛网膜下腔出血管理的相关性。
