经侧脑室短期重复应用重组链激酶预防动脉瘤破裂后迟发性脑血管痉挛

Preventive Effect of Recombinant Streptokinase on Delayed Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage by Repeated Injections into Lateral Ventricle

目的 :观察经侧脑室短期重复应用重组链激酶 (r SK)并引流脑脊液 ,对预防脑动脉瘤破裂蛛网膜下隙出血 (SAH)后迟发性脑血管痉挛 (DCV)的效果。方法 :14例脑动脉瘤破裂Fisher 3级患者 ,于 72h内行瘤颈夹闭或瘤体介入栓塞术 ,以及侧脑室外引流后 ,分为治疗组和对照组 ,各 7例。治疗组经侧脑室注入r SK 5mg·d-1,连续 2～ 3d。术后出现迟发性神经功能损害者诊断为DCV ;术后 1～ 3个月以GOS评估预后。结果 :治疗组术后SAH血凝块 3～ 4d消失 ,无DCV发生 ,GOS均为 5分。对照组术后 4～ 10d血凝块消失 ,3例无DCV发生 ,GOS为 5分 ;4例DCV者 ,2例GOS为 4分、3分和 1分各 1例。结论 :经侧脑室短期重复应用r SK ,对防治SAH后DCV有较好的疗效。

Aim:Preventing patients with aneurysm from delayed cerebral vasospasm (DCV) after subarachnoid hemorrhage (SAH) was evaluated by repeated injections of recombinant streptokinase (r-SK)into lateral venticle in short period coupled with drainge of cerebral spinal fluid (CSF).Methods:14 patients classified as Fisher Grade 3 were treated with venticulostomy and surgery for aneurysm clipping or Guglielmi detachable coils (GDC) within 72 hours after aneurysm rupture. 7 patients of them were treated with r-SK (5mg everyday)by injection into lateral ventricle,and other 7 as control.Symptomatic DCV was diagnosed as the onset of delayed neurological deteriotation.Functional prognosis was evaluated 1 month after SAH or discharge according to the Glasgow Outcome Scale.Results:The clot was cleared completely within 3 to 4 days after surgery or GDC for patients with r-SK (dosage 10～15mg) who had good recovery;while within 4 to 10 days for control patients,3 had good recovery,2 were moderately disabled,1 was severe disabled and another died.Conclusion:Repeated injection of r-SK into lateral ventricle in short period coupled with drainage of CSF was a good method for preventing patients with aneurysm from DCV after SAH.