重组组织型纤溶酶原激活剂联合脑室外引流治疗脑室出血的临床观察
Clinical observation on combined recombinant tissue plasminogen activator with extraventricular drainage in the treatment of intraventricular hemorrhage

许峰等.重组组织型纤溶酶原激活剂联合脑室外引流治疗脑室出血的临床观察[J].内科急危重症杂志,2020,26(3):188-190

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DOI：10.11768/nkjwzzzz20200303

中文关键词: 脑室出血脑室外引流重组组织型纤溶酶原激活剂再出血脑积水预后

英文关键词:

基金项目:国家自然科学基金面上项目(No：81974218，81671064，81371222；自主创新基金(No:540-5003540062，540-5003540083)；国家科技基础资源调查专项(No:2018FY100900)

作者	单位	E-mail
许峰等	华中科技大学同济医学院附属同济医院	zhusuiqiang@163.com

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中文摘要:

目的：探索重组组织型纤溶酶原激活剂（rtPA）联合脑室外引流(EVD)治疗脑室出血的安全性和有效性。方法：回顾性分析接受EVD治疗的脑室出血患者69例，依据是否给予脑室局部注入rtPA分为rtPA组(15例)和对照组(54例)。采用计算机辅助、半定量的容量分析方法计算脑室血肿体积，比较2组患者血肿清除效果、脑室积血程度（Graeb评分）、意识水平（GCS评分）、30d并发症、病死率及临床预后良好（Rankin评分＜3分）患者的比例。结果：术后第7天，rtPA组脑室血肿体积明显小于对照组 [(13.38±13.90)mL vs (28.48±17.65)mL，P＜0.05）]，Graeb评分明显低于对照组 [3（2,4）vs 5(4.5,5.5),P<0.05]，GCS评分与对照组比较差异无统计学意义 [10（8,12）vs 8(7,12),P>0.05]。2组患者30d内颅内感染、再出血、交通性脑积水的发生率、病死率及临床预后良好患者的比例比较，差异无统计学意义（均P＞0.05）。结论：与单纯的EVD相比，EVD联合脑室局部注入rtPA治疗脑室出血可以更快速地清除脑室血肿.

英文摘要:

Objective: To explore the safety and efficacy of recombinant tissue plasminogen activator (rtPA) combined with extraventricular drainage (EVD) in the treatment of intraventricular hemorrhage (IVH). Methods: A retrospective analysis was performed on 69 patients with IVH who were treated with EVD. According to whether they were given rtPA or not, these patients were divided into rtPA group (15 cases) and control group (54 cases). The volume of intraventricular hematoma was calculated by computer aided and semi quantitative volume analysis. The effect of hematoma evacuation, the degree of intraventricular hematocele (Graeb score), the level of consciousness (GCS score), the 30 day complications, mortality and the proportion of patients with good clinical prognosis (Rankin score < 3) were compared in two groups. Results: On the 7th day after operation, the volume of ventricular hematoma in rtPA group was significantly smaller than that in the control group [(13.38 ± 13.90)mL vs (28.48 ± 17.65)mL, P< 0.05], the Graeb score was significantly lower than that in the control group [3(2,4) vs 5(4.5,5.5), P<0.05], but the GCS score was not significantly different from that in the control group [10(8,12) vs 8(7,12), P>0.05]. There was no significant difference between the two groups within 30 days with regard to the incidence of intracranial infection, rebleeding, communicating hydrocephalus, mortality and the proportion of patients with good prognosis, respectively (P>0.05). Conclusion: Compared with EVD alone, EVD combined with local rtPA infusion may accelerate the reduction of ventricular hematoma.