大剂量尿激酶联合地塞米松在脑室出血中的临床应用研究

Research on Clinical Application of Large Dose of Urokinase combined with Dexamethasone in Treating Intraventricular Hemorrhage

目的:研究大剂量尿激酶配合地塞米松在脑室出血中临床应用的疗效。方法:对2009年3月至2011年11月诊断的52例脑室出血病人行脑室穿刺引流术后采用大剂量尿激酶联合地塞米松脑室内灌注。结果:随访3个月,按格拉斯哥预后评分(GOS):恢复良好37例(71%),中残10例(19%),重残2例(4%),死亡3例(6%)。生存患者按日常生活能力(ADL)分级情况:ADL1者14例,ADL2者21例,ADL3者12例,ADL4者2例。结论:脑室出血病人早期行脑室穿刺引流术后采用大剂量尿激酶灌注脑室内,可加快脑室内血凝块的溶解速度和清除时间,联合地塞米松(5mg)灌注脑室内,可减少迟发性脑积水的发生,改善患者预后,降低病死率,值得临床推广应用。

Objective： To explore the effect of large dose of urokinase combined with dexamethasone in treating patients with intraventricular hemorrhage. Methods： 52 patients with intraventricular hemorrhage were treated with large dose of urokinase combined with dexamethasone injected into the lateral ventricle followed by ventricular drainage from Mar 2009 to Nov 2011. Results： Glasgow Outcome Score （GOS） detection after the follow-up for 3 months showed that 37 cases （71% ） were good recovery, 10 cases （ 19% ） were moderate disability, 2 cases （4%） were severe disability and 3 cases （6%） were dead. The survivors were evaluated by activities of daily life （ADL）grade, 14 cases were grade 1, 21 cases were grade 2, 12 cases were grade 3, 2 cases were grade 4. Conclusion： The patients with intraventricular hemorrhage were treated with large dose of urokinase combined with dexamethasone injected into the lateral ventricle followed by ventricular drainage at early stage can accelerate the dissolution rate and clearing time of hematoma in ventricle significantly. Simultaneously, the use of dexamethasone can decrease appear of delayed hydrocephalus. It is worth to be extended that the method may improve the prognosis and decrease the mortality rate.