Rohde V, Schaller C, Hassler W E
Department of Neurosurgery, Klinikum Kalkweg, Duisburg, Germany.
J Neurol Neurosurg Psychiatry. 1995 Apr;58(4):447-51. doi: 10.1136/jnnp.58.4.447.
A prospective series of 20 patients with moderate to severe intraventricular haemorrhage (IVH) was studied for the effect of intraventricular administration of recombinant tissue plasminogen activator (rt-PA) on reduction of haematoma volume and prognosis. On the day of haemorrhage ventriculostomy was performed and 2 to 5 mg of rt-PA were injected via the external ventricular drainage, followed by drainage closure for two hours. In 14 patients rt-PA treatment was repeated. Computed tomography showed complete clot lysis or substantial reduction of intraventricular haematoma volume in 19 patients within 96 hours; the clearance of the third and fourth ventricle preceded the clearance of the lateral ventricles. Decrease of ventricular enlargement was seen in all but one patient with initial ventricular dilatation. Increase of haematoma volume and ventricular size was found in one patient. Outcome was minor or no neurological deficit in nine patients, disabling neurological deficit in six patients, and vegetative status in four patients. One patient did not survive the IVH. Intraventricular treatment with rt-PA seems effective in rapid lysis of intraventricular haematoma and normalisation of impaired CSF circulation. This treatment may contribute to an improvement in prognosis of moderate to severe IVH.
对20例中重度脑室内出血（IVH）患者进行前瞻性研究，以探讨脑室内注射重组组织型纤溶酶原激活剂（rt-PA）对减少血肿体积和改善预后的效果。出血当天进行脑室造瘘术，通过脑室外引流注入2至5毫克rt-PA，然后封闭引流两小时。14例患者重复进行rt-PA治疗。计算机断层扫描显示，19例患者在96小时内血肿完全溶解或脑室内血肿体积大幅减少；第三和第四脑室的清除先于侧脑室的清除。除1例初始脑室扩张的患者外，其余患者均可见脑室扩大程度减轻。1例患者出现血肿体积和脑室大小增加。9例患者预后为轻度或无神经功能缺损，6例患者为致残性神经功能缺损，4例患者为植物状态。1例患者在脑室内出血后死亡。脑室内注射rt-PA似乎能有效快速溶解脑室内血肿并使受损的脑脊液循环恢复正常。这种治疗可能有助于改善中重度IVH的预后。
