摘要
目的 观察经侧脑室短期反复应用尿激酶 (UK)和维生素C(VitC) ,并行侧脑室外引流 ,对预防动脉瘤破裂后迟发性脑血管痉挛 (DCVS)的效果。方法 发病后 4 8h内 ,手术夹闭瘤颈和侧脑室外引流治疗FisherⅢ级动脉瘤破裂 30例。经侧脑室注射UK和VitC治疗 15例 ,对照组 15例 ,以迟发性神经功能损害作为症状性DCVS的诊断依据 ,评估预后。结果 UK和VitC治疗组术后 3～ 4d血凝块消失 ,无DCVS的发生 ,预后良好 ;对照组术后 5～ 10d血凝块消失 ,6例预后良好 ,7例中度病残 ,2例死亡。结论 经侧脑室短期反复应用UK和VitC及侧脑室外引流 ,对预防蛛网膜下腔出血 (SAH)后DCVS有较好的疗效。
Objective Effect of prevention from delayed cerebral vasospasm (DCVS) after subarachnoid hemorrhage (SAH) were evaluated in patients with aneurysm rupture by repeated injection of urokinase (UK) and Vit C into lateral ventricle in short period combined with drainage of cerebrospinal fluid (CSF). Methods 30 patients classified as Fisher grade Ⅲ were treated with ventriculostomy and aneurysm clipping within 48 hours after aneurysm rupture. Out of them,15 patients were treated with UK and Vit C by injection into lateral ventricle, and others as control. Symptomatic DCVS was diagnosed as the onset of delayed neurological deterioration. Functional prognosis was evaluated after SAH or discharge according to the glasgow outcome scale. Results The clot was cleared completely within 3 to 4 days after surgery for the patients by repeated injection of UK and Vit C into lateral ventricle, who had good recovery, while only 6 patients were recovered completely within 5 to 10 days in control groups,7 moderately disabled and 2 dead. Conclusion The effects suggested that repeated injections of UK and Vit C into lateral ventricle in short period combined with drainage of CSF is a good method for the prevention of DCVS in the patients with SAH.
