Fabiano Andrew J, Gruber Thomas J, Baxter Melissa S
Department of Neurosurgery, School of Medicine and Biomedical Sciences, Buffalo, USA; Department of Neurosurgery, Roswell Park Cancer Institute, Buffalo, USA.
Clin Neurol Neurosurg. 2013 Nov;115(11):2362-4. doi: 10.1016/j.clineuro.2013.08.018. Epub 2013 Aug 27.
Intraventricular tissue plasminogen activator (alteplase) has been advocated for prevention of vasospasm in aneurysmal subarachnoid hemorrhage and treatment of traumatic or spontaneous intraventricular hemorrhage. External ventricular drain (EVD) insertion is often performed to manage increased intracranial pressure and hydrocephalus associated with these disease states. EVD-related ventriculitis is a serious infection with an up to 50% mortality rate.
We assessed the EVD infection rate in patients receiving intraventricular alteplase over a 12-month period. Patients were divided into intraventricular alteplase and non-intraventricular alteplase groups; ventriculitis rates were compared.
EVDs were placed in 93 patients. Six of 7 (86%) patients who received intraventricular alteplase developed ventriculitis versus 4 of 86 (5%) patients in the non-intraventricular alteplase group (p<0.0001).
Intraventricular alteplase use may increase ventriculitis risk. Currently, we reserve intraventricular alteplase for patients with EVDs obstructed by hematoma accompanied by increased intracranial pressure.
脑室内注射组织型纤溶酶原激活剂（阿替普酶）已被推荐用于预防动脉瘤性蛛网膜下腔出血后的血管痉挛以及治疗外伤性或自发性脑室内出血。常通过插入脑室外引流管（EVD）来处理与这些疾病状态相关的颅内压升高和脑积水。EVD相关的脑室炎是一种严重感染，死亡率高达50%。
我们评估了在12个月期间接受脑室内阿替普酶治疗的患者的EVD感染率。患者被分为脑室内阿替普酶组和非脑室内阿替普酶组；比较两组的脑室炎发生率。
93例患者接受了EVD置入。接受脑室内阿替普酶治疗的7例患者中有6例（86%）发生脑室炎，而非脑室内阿替普酶组的86例患者中有4例（5%）发生脑室炎（p<0.0001）。
使用脑室内阿替普酶可能会增加脑室炎风险。目前，我们仅将脑室内阿替普酶用于因血肿阻塞EVD且伴有颅内压升高的患者。
