Aiuto L T, Barone S R, Cohen P S, Boxer R A
Department of Pediatrics, North Shore University Hospital-New York University School of Medicine, Manhasset 11030, USA.
Crit Care Med. 1997 Jun;25(6):1079-82. doi: 10.1097/00003246-199706000-00028.
To investigate whether an infusion of recombinant tissue plasminogen activator would dissolve microvascular thromboses and improve organ perfusion in a patient with fulminant meningococcemia.
Descriptive case report.
Fifteen-bed pediatric intensive care unit (ICU) in a university hospital.
A 4-month-old male with fulminant meningococcemia, refractory shock, and multiple organ failure.
In addition to standard aggressive ICU care, the patient received a recombinant tissue plasminogen activator infusion at a total dose of 1.25 mg/kg over 4 hrs.
Heart rate, arterial blood pressure, urine output, and base deficit (as a reflection of severity of metabolic acidosis) were recorded immediately before the recombinant tissue plasminogen activator infusion and 4 hrs later, after completion of the recombinant tissue plasminogen activator infusion. The amount of exogenous vasopressor and inotropic support required to maintain the patient's hemodynamic status before and after recombinant tissue plasminogen activator infusion were also compared. Subjective observations regarding the patient's peripheral perfusion status were also noted. The patient showed a dramatic improvement in hemodynamics, urine output, and metabolic acidosis, as well as a perceived increase in skin perfusion after recombinant tissue plasminogen activator infusion.
In this patient, recombinant tissue plasminogen activator infusion resulted in improved organ perfusion and cardiac performance. Selective use of recombinant tissue plasminogen activator in the treatment of fulminant meningococcemia merits further investigation.
探讨静脉输注重组组织型纤溶酶原激活剂是否能溶解暴发性脑膜炎球菌血症患者的微血管血栓并改善器官灌注。
描述性病例报告。
一所大学医院的拥有15张床位的儿科重症监护病房（ICU）。
一名4个月大的男性，患有暴发性脑膜炎球菌血症、难治性休克和多器官功能衰竭。
除了标准的积极ICU治疗外，患者在4小时内接受了总量为1.25mg/kg的重组组织型纤溶酶原激活剂输注。
在输注重组组织型纤溶酶原激活剂之前以及输注结束4小时后，记录心率、动脉血压、尿量和碱缺失（反映代谢性酸中毒的严重程度）。还比较了输注重组组织型纤溶酶原激活剂前后维持患者血流动力学状态所需的外源性血管升压药和正性肌力支持的用量。同时也记录了关于患者外周灌注状态的主观观察结果。输注重组组织型纤溶酶原激活剂后，患者的血流动力学、尿量和代谢性酸中毒有显著改善，皮肤灌注也明显增加。
在该患者中，输注重组组织型纤溶酶原激活剂可改善器官灌注和心脏功能。在暴发性脑膜炎球菌血症治疗中选择性使用重组组织型纤溶酶原激活剂值得进一步研究。
