Spallone A, Pastore F S, Rizzo A, Guidetti B
Department of Neurological Sciences, University of Rome, School of Medicine, Italy.
Neurochirurgia (Stuttg). 1987 Nov;30(6):172-6. doi: 10.1055/s-2008-1054089.
Among our patients with ruptured intracranial aneurysms 149 were managed pre-operatively with a combination of tranexamic acid (AMCA), 3 gm daily, and aprotinin at an average of 400,000 KIU (Kallikrein inactivating units) daily. Antifibrinolytics were started within three days of the last haemorrhage, and continued for at least six days. The first 91 cases, managed in the years 1971 to 1980, have been evaluated retrospectively. The remaining 58 patients were managed in the period 1981-1985 and carefully watched for possible complications of treatment. No significant differences were noted in the results of patients managed either before or after 1981. The rate of recurrent SAH (10%) was lower than the natural history of aneurysmal SAH. Satisfactory inhibition of fibrinolysis was documented in the CSF collected at the time of operation in 15 patients. This, as well as our previous suggestions that the combination of low-dose AMCA and aprotinin might carry a lesser risk of causing ischaemic complications and hydrocephalus than the conventional antifibrinolytic treatment, might stimulate future studies on fibrinolysis in SAH.
在我们的颅内动脉瘤破裂患者中，149例在术前接受了氨甲环酸（AMCA）联合治疗，每日3克，以及抑肽酶治疗，平均每日400,000 KIU（激肽释放酶灭活单位）。抗纤溶药物在最后一次出血后三天内开始使用，并持续至少六天。对1971年至1980年治疗的前91例患者进行了回顾性评估。其余58例患者在1981 - 1985年期间接受治疗，并仔细观察治疗可能的并发症。1981年前后治疗的患者结果未发现显著差异。复发性蛛网膜下腔出血（SAH）的发生率（10%）低于动脉瘤性SAH的自然病程。在15例患者手术时收集的脑脊液中记录到纤溶得到了满意的抑制。这一点，以及我们之前的观点，即低剂量AMCA和抑肽酶联合使用可能比传统抗纤溶治疗引起缺血性并发症和脑积水的风险更小，可能会激发未来对SAH纤溶的研究。
