Hudgins R J, Boydston W R, Hudgins P A, Morris R, Adler S M, Gilreath C L
Department of Pediatric Neurosurgery, Scottish Rite Children's Medical Center, Atlanta, Ga, USA.
Pediatr Neurosurg. 1997 Jun;26(6):281-7. doi: 10.1159/000121207.
Despite improvements in the care of preterm infants, intraventricular hemorrhage (IVH) and posthemorrhagic hydrocephalus (PHH) continue to be frequent occurrences in this patient population. Shunt procedures in these children are frequently complicated by obstruction and/or infection. As the hydrocephalus is usually caused by an obliterative arachnoiditis due to contact of the blood with the basilar meninges, it was postulated that infusion of urokinase into the ventricles of infants who have sustained an IVH would clear the blood, mitigate the arachnoiditis, and prevent the progression of PHH. Accordingly, 18 preterm infants who had sustained IVH and subsequently developed PHH were treated with intraventricular urokinase instilled via a surgically implanted subcutaneous reservoir. There were no complications associated with the urokinase. Infants were divided into two dosage groups: low dose (110,000-140,000 IU total) and high dose (280,000 IU total). One infant in the low-dose group died at 1 month of life of respiratory complications. In the low-dose group, 3 of 8 (37%) infants required shunt placement; in the high-dose group, all 9 required shunt placement. For the total group, the shunt rate was 71%. This compares to a historical control group shunt rate of 92%. While the difference between the treatment group as a whole and control group approaches, but does not reach, statistical significance (p = 0.068), there was a significant reduction in the shunt rate when the low-dose group was considered separately (p < 0.002). For those infants that required shunt placement, there were fewer shunt revisions performed in the treatment group than in the control group during the first 24 months following shunt placement: 0.67 versus 1.5 shunt revisions/shunted child. Initial experience with intraventricular urokinase following IVH and PHH in preterm infants suggests a beneficial effect in reducing the shunt revision rate in both high- and low-dose groups. Reduction in shunt placement rate is seen only in the low-dose group.
尽管早产儿护理有所改善，但脑室内出血（IVH）和出血后脑积水（PHH）在该患者群体中仍然频繁发生。这些儿童的分流手术经常因阻塞和/或感染而复杂化。由于脑积水通常是由血液与基底脑膜接触导致的闭塞性蛛网膜炎引起的，因此有人推测，向发生IVH的婴儿脑室内注入尿激酶可以清除血液，减轻蛛网膜炎，并防止PHH进展。因此，18名发生IVH并随后发展为PHH的早产儿通过手术植入的皮下储液器向脑室内注入尿激酶进行治疗。未发生与尿激酶相关的并发症。婴儿被分为两个剂量组：低剂量组（总量110,000 - 140,000国际单位）和高剂量组（总量280,000国际单位）。低剂量组中有1名婴儿在1个月大时因呼吸并发症死亡。在低剂量组中，8名婴儿中有3名（37%）需要进行分流置管；在高剂量组中，9名婴儿全部需要进行分流置管。对于整个组，分流率为71%。相比之下，历史对照组的分流率为92%。虽然整个治疗组与对照组之间的差异接近但未达到统计学显著性（p = 0.068），但单独考虑低剂量组时，分流率有显著降低（p < 0.002）。对于那些需要进行分流置管的婴儿，在分流置管后的前24个月内，治疗组进行的分流修正手术比对照组少：每例分流儿童的分流修正手术次数分别为0.67次和1.5次。早产儿IVH和PHH后脑室内注入尿激酶的初步经验表明，高剂量组和低剂量组在降低分流修正率方面均有有益效果。仅在低剂量组中观察到分流置管率降低。
