脑室出血患者脑室内灌注尿激酶时脑脊液中D-二聚体的动态变化及意义

The Dynamics and Significance of D-dimer in Intraventricular Hemorrhage Patients Receiving Intraventricular Infusion of Urokinase

目的探讨脑室出血后脑室系统是否具有纤溶能力及应用外源性尿激酶(UK)是否有助于增强纤溶的活性。方法 34例脑室出血患者,其中17例患者行侧脑室穿刺外引流,为no-UK组;另17例患者行侧脑室穿刺外引流+尿激酶脑室内灌注治疗,为UK组。采用ELISA法测量穿刺后0、2、4、6、12 h点脑脊液标本中D-二聚体(D-D)含量。结果 no-UK组脑脊液中D-D含量随时间而增加,相邻2个时间点间比较P<0.05;UK组5个时间点脑脊液D-D含量进行两两比较,与0 h点比较,2、4 h点显著升高(P<0.01),6、12 h点仍高于0 h点(P<0.05)。两组间D-D含量在2 h(P<0.01)和4 h(P<0.05)时比较差异有统计学意义,0、6、12 h时比较差异无统计学意义(P>0.05)。重复测量数据的方差分析显示时间因素、时间因素与分组因素的交互作用、分组因素均有统计学意义。结论脑室出血后脑脊液中D-D含量随时间增加,且可被外源性UK的应用而增强,表明在脑室出血后的脑室系统内应用UK是可行的。

Objective To investigate whether ventricular systems has fibrinolytic ability after intraventricular hemorrhage（IVH）and whether application of exogenous urokinase（UK）help to enhance the fibrinolytic activity.Methods 34 severe IVH patients with the treatment of external ventricular drainage（EVD）were randomly divided into two groups,UK group and no-UK group.In UK group,all patients were treated with EVD and intraventricular infusion of urokinase,but in no-UK group,patients with only EVD.The CSF samples 2 ml were obtained at 0,2,4,6 and 12 h after operation of EVD to test the D-dimer（D-D）fcontent by ELISA method.Results In no-UK group,the contents of D-D in CSF increased with time,the differences were significant between each neighbour time-point（P0.05）.In UK group,the contents of D-D at 2,4h points increased significantly when compared with that at 0h（P0.01）,the levels of D-D at 6h and 12h were still higher than that at 0h（P0.05）.At the same time points,the levels of D-D were significantly higher at 2,4h point in UK group than in no-UK group（P0.05）,while there were no significant differences between two groups at 0,6,12h point（P0.05）.Repeated measures ANOVA results showed that time factors,time×group,group factor all had statistical significance.Conclusion The contents of D-D increases in CSF after IVH and can be enhanced by an intraventricular infusion of exogenous urokinase,which suggests that it is feasible to treat IVH patients with urokinase.