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r-tPA治療腦室內血腫價值及相關併發症研究
Study on the value of r-tPA in the treatment of intraventricular hematoma and related complications
摘要
目的：通過總結鏡湖醫院神經外科治療的腦室內血腫患者的資料，明確r-tPA治療腦室內血腫的价值及併發症發生率。方法：收集2009年1月～2017年1月期間鏡湖醫院神經外科治療的121例腦室內血腫患者中，其中使用r-tPA治療的有56例，單純腦室外引流或開顱血腫清除＋置管引流（稱“對照組”）的65例，分別收集兩組病人的GCS評分，mRS評分、GOS評分，腦室內血腫清除的情況及各種併發症發生率相關進行總結。結果：r-tPA注射組中，4/56（7%）例病人的死亡，對照組中，11/65（16.9%）例死亡。腦室內血腫清除72h Graeb評分r-tPA注射組為3.00±1.92，對照組為9.00±2.78。GOS評分為1～2分患者在r-tPA注射組為28/56（50%），對照組為21/65（32.3%）。r-tPA注射組患者並發新鮮出血6/56例（10.7%），對照組術後並發新鮮出血的病人1/65例（1.5%）。r-tPA注射組注射r-tPA後顱內壓升高6/56例（10.7%）、併發心律失常4/56例（7.1%），併發引流管堵塞1/56例（1.8%），對照組引流管堵塞7/65例（10.8%）。注射r-tPA治療結束後出現腦積水需要行腦室腹腔分流的9/56例（16.1%）。而對照組有27/65例（41.5%）。結論：經腦室外引流管注射r-tPA治療腦室內積血是一種有效的治療措施，能加快腦室內血腫的溶解排除，減少引流管堵塞，降低病人腦積水併發症。然而部份病人在開顱血腫清除、去除顱骨減壓或引流管放置在血腫腔內均增加繼發出血風險。同時需控制注射藥物的液體總量及注射溶液的溫度，避免ICP升高或並發心率失常、抽搐等併發症。
並列摘要
Objective: To summarize the data of 121 patients with intraventricular hematoma treated by neurosurgery in Kiang Wu Hospital, and to determine the value of r-tPA in the treatment ofintraventricular hematoma and the incidence of complications. Methods: A total of 121 patients within traventricular hematoma who underwent neurosurgical treatment in Kiang Wu Hospital from January 2009 to January 2017. 56 patients were treated with r-tPA, 65 patients were treated with extra-ventriculardrainage alone. The two groups of patients before and after treatment GCS score, mRS score, GOS score,intraventricular hematoma removal of the situation, the dose of injection drugs and complications of various complications of the data were summarized. Results: Of the 4/56 (7%) patients died in the r-tPA group,11/65 (16.9%) died in the patients underwent extra-ventricular drainage alone. Intraventricular hematoma evacuation 72h Graeb score with r-tPA injection group was 3 ± 1.92, the control group was 9 ± 2.78. The GOSscore of 1-2 patients was 28/56 (50%) in the r-tPA group and 21/65 (32.3%) in the control group. There were 6 cases (10.7%) of new bleeding in the treatment group and 1 case (1.5%) of new bleeding in the control group. 6 patients(10.7%) with high intracranial pressure after injection of r-tPA. 4 patients (7.1%)developed arrhythmia after injection of r-tPA. In the treatment group, drainage tube obstruction developed in 1 patient(1.8%). There were 7(10.8%) patients of the drainage tube obstruction in the control group. In the treatment group, 9 patients (16.1%) were needed to do ventriculoperitoneal shunt due to hydrocephalus. However, in the control group, 27patients (41.5%) need to do ventriculoperitoneal shunt. Conclusion: Injectionof r-tPA through the drainage tube is an effective method of treatment of intraventricular hematoma. It can speed up the dissolution and discharge of intraventricular hematoma, reduce the probability of drainage tube blockage, and reduce the patient mortality and the risk of hydrocephalus. However, we must carefully choose suitable cases for the treatment, and reduce fresh bleeding complications caused by the injection of drugs. We must stringently adjust the dose of the drug to be injected and the temperature of the injection solution.