Luciano R, Tortorolo L, Chiaretti A, Piastra M, Velardi F, Polidori G
Institute of Pediatrics, Catholic University of Rome, Italy.
Intensive Care Med. 1998 May;24(5):526-9. doi: 10.1007/s001340050606.
Neonatal post-haemorrhagic hydrocephalus is a clinical condition with a high mortality and long-term morbidity. Its clinical management is difficult and not well standardized. We describe the case of a term baby suffering from acute intracranial hypertension caused by an intraventricular and thalamic haemorrhage. In this case, the external ventricular drain inserted to control intracranial pressure was ineffective because of repeated obstructions due to blood clots. Continuous intraventricular infusion of streptokinase of 20,000 U/day allowed quick lysis of the clots, drainage of the cerebrospinal fluid and relief from the coma. Although it did not prevent a permanent ventriculoperitoneal shunt, we obtained reabsorption of the intraventricular haemorrhage without rebleeding complications. We suggest the use of low-dose fibrinolytic infusion through an external drain for the treatment of acute intracranial hypertension following intraventricular haemorrhage in term infants.
新生儿出血后脑积水是一种死亡率高且伴有长期发病的临床病症。其临床管理困难且未得到很好的规范。我们描述了一例足月儿因脑室内和丘脑出血导致急性颅内高压的病例。在该病例中，为控制颅内压插入的外部脑室引流管因血凝块反复阻塞而无效。每天持续脑室内输注20,000单位链激酶可使血凝块迅速溶解、脑脊液引流并使患儿从昏迷中苏醒。尽管它未能防止永久性脑室腹腔分流，但我们实现了脑室内出血的吸收且无再出血并发症。我们建议通过外部引流管进行低剂量纤维蛋白溶解剂输注，用于治疗足月儿脑室内出血后的急性颅内高压。
