r-tPA腦室内灌注對腦室型高血壓腦出血治療價值研究

Study the value of using intraventricular r-tPA in treating the patients with IVH caused by hypertension

目的回顧腦室型高血壓腦出血的治療結果,探討r-tPA在治療腦室型高血壓腦出血中價值。方法收集並統計本院2005年5月至2011年4月期間經CTA、MRA或DSA檢查排除動脈瘤或血管畸形所致腦室内出血,幷行腦室外引流手術的患者資料。結果統計結果表明,56例入選的患者中27例患者單純給予腦室外引流手術,29例患者在行腦室外引流基礎上給予腦室内保留灌注r-tPA治療。入院時兩組病人GCS及Graeb評分相似,r-tPA腦室内灌注治療對清除側腦室、III、IV腦室内血塊有明顯優勢,對降低腦出血後繼發腦積水需行V-P shunt手術率有效果(P=0.039),但對改善患者GOS評分無明顯幫助,而腦室内注射r-tPA並不會增加幷發症的發生。結論腦室内灌注r-tPA纖溶治療中、重度IVH可以加快腦室内血腫的清除、减少引流管堵塞,從而降低患者的致殘率及降低因腦積水需行分流手術的比率,治療過程中無明顯副反應發生。

Objective Our objective was to review our experience using intraventricular(r-tPA)in treating selected patients with IVH caused by hypertension.Methods Using medical records,we identified all patients who received ventriculostomies for CTA MRA or DSA confirmed non-aneurysmal,non-vascular malformation spontaneous IVH from May 2005 through April 2011.We reviewed charts and CT images and examined the data for associations with specific outcomes.Results We identified 56 patients,27 treated with ventriculostomy alone and 29 receiving adjunctive intraventricular r-tPA.The clinical features of the 56 patients in two groups showed no significant differences in age or Glasgow Coma Scale assessment on admission.There was also no significant difference in Graeb score between the alone EVD group and the receiving adjunctive intraventricular r-tPA group.Patients who received r-tPA had significantly greater blood casting of the third and fourth ventricle.The VP shunt rates were 10.7%in the receiving adjunctive intraventricular r-tPA group and 17.3%in the EVD alone group.The receiving adjunctive intraventricular r-tPA group had a significant lower VP shunt rate(P=0.039)compared with the EVD alone group.Overall,the most significant association with outcome was neurological condition at presentation.Receiving r-tPA did not increase the occurrence of complications.Conclusion Intraventricular thrombolysis with r-tPA seems to assist in the management of patients with moderately or severe IVH,speeding clearance of intraventricular hemorrhage and reducing ventricular catheter obstruction,and it appeared to lower mortality,lower shunt-dependent hydrocephalus.