文章摘要
连立飞，许峰，梁奇明，朱文浩，潘超，王刚，张逸驰，王芙蓉，唐洲平，朱遂强.颅内血肿微创抽吸引流术联合rt-PA治疗自发性 脑出血的初步观察[J].神经损伤功能重建,2018,13(3):113-116
颅内血肿微创抽吸引流术联合rt-PA治疗自发性 脑出血的初步观察
Preliminary Study of Minimally Invasive Intracranial Hematoma Evacuation SurgeryCombined with rt-PA in Patients with Spontaneous Intracerebral Hemorrhage
  
DOI：
中文关键词: 脑出血  微创术  血肿清除  重组组织型纤溶酶原激活剂
英文关键词: intracerebral hemorrhage  minimally invasive surgery  clot evacuation  recombinant tissue-type plasminogen activator
基金项目:卫生部部属（管）医 院临床学科重点项 目（No.JX4A03）； 同济医院引领未来 临床诊疗新技术新 业务基金项目； 华中科技大学同济 医学院重大疾病交 叉创新团队培育计 划
作者单位
连立飞，许峰，梁奇明，朱文浩，潘超，王刚，张逸驰，王芙蓉，唐洲平，朱遂强 华中科技大学同济 医学院附属同济医 院神经内科 
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中文摘要:
      目的：评估颅内血肿微创抽吸引流术（微创术）联合重组组织型纤溶酶原激活剂（rt-PA）治疗自发性脑 出血的可行性和可能的rt-PA用药方案。方法：回顾性分析接受微创术联合rt-PA治疗的脑出血患者。容量 分析方法计算血肿体积和灶周水肿体积，改良的 Rankin 量表（mRS）评估预后（mRS 0~3 v.s.4~5），并比较 30 d的实际死亡率与预估死亡率。结果：共纳入患者45例。rt-PA中位用药次数和量为2（1）次和1.5（1）mg， 最大量4.0 mg。术后血肿和水肿体积明显小于术前（P=0.000；P=0.000）。穿刺准确度与残余血肿体积明显 负相关（ρ=－0.61；P＜0.01）。拔针时GCS评分明显高于入院时（P=0.000）。30 d时实际死亡率为0，远低于 预估死亡率（46.7%）。微创期间无颅内感染发生，再出血2例。中位数随访2.5年，5例死亡、3例失访，21例 预后好（mRS 0~3）（46.7%）。结论：微创术联合小剂量rt-PA治疗脑出血有助于加速血肿清除、降低30 d死亡 率和可能改善长期预后。0.5~1.0 mg/12~24 h、≤4.0 mg的rt-PA应用方案可能适合我国脑出血微创人群。
英文摘要:
      To evaluate the feasibility and safety of minimally invasive intracranial hematoma suction drainage surgery (MIS) plus intraclot use of recombinant tissue-type plasminogen activator (rt-PA) in patients with spontaneous intracerebral hemorrhage (ICH) and to explore the potential treatment regimen of intraclot rt-PA. Methods: Patients with ICH treated with MIS and intraclot rt-PA were retrospectively identified. A volumetric analysis to assess hematoma and perihematomal edema (PHE) volumes was conducted. Glasgow Coma Score (GCS) was used to assess consciousness. The modified Rankin Scale (mRS) was used for scoring clinical outcomes (mRS 0~3 v.s. 4~5). The observed 30-day cohort mortality was compared with its predicted mortality. Results: Forty-five patients were included. The median number of doses and dose of rt-PA was 2 (1) doses and 1.5 (1) mg, with a maximum cumulative dose of 4.0 mg. The ICH volume and PHE volume post-MIS was significantly lower compared with that of pre-MIS, respectively (P=0.000; P=0.000). There was a significantly negative correlation between puncture accuracy and residual hematoma volume (ρ = －0.61; P < 0.01). GCS at post-MIS was significantly higher than that at pre-MIS (P=0.000). The 30-day patient morality was 0, significantly lower than the predicted mortality (46.7%). No patients developed intracranial infection, and only 2 patients experienced rebleeding. The patients were followed up for a median of 2.5 years; 5 patients died, 3 patients lost contact, and 21 patients had good outcomes (mRS 0~3). Conclusion: MIS combined with low dose rt-PA in the treatment of ICH enhances clot evacuation, lowers 30-day mortality, and improves long-term clinical outcome. The rt-PA dosage regimen of 0.5～1.0 mg/12～24 h, ≤4.0 mg cumulative may be favorable for treatment in ICH patients receiving minimally invasive surgery
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