脑室内灌注尿激酶对脑室出血后脑脊液中D-二聚体含量的影响  

Effect of intraventricular infusion of urokinase on cerebrospinai fluid D - dimer in severe intraventricular hemorrhage patients

作　　者：徐伟[1] 罗自勉 宋治[3] 李辉萍[4] 王振[1] 

机构地区：[1]长沙市中心医院,410004 [2]湘潭市中心医院,湖南411100 [3]中南大学湘雅三医院,长沙410013 [4]湖南省马王堆医院,长沙410006

出　　处：《中国急救医学》2010年第8期742-744,共3页Chinese Journal of Critical Care Medicine

摘　　要：目的通过研究脑室内灌注尿激酶对脑室出血（IVH）后脑脊液中D-二聚体含量的影响，探讨脑室出血后脑室内应用尿激酶（UK）的可行性。方法34例重型脑室出血患者，其中17例行单纯侧脑室穿刺外引流（external ventncular drainage，EVD）治疗，为non-UK组；另外17例行EVD＋尿激酶脑室内灌注（intraventricular infusion of urokinase，IVIU）治疗，为UK组。采用ELISA方法测量各组穿刺后0、2、4、6及12h时间点脑脊液中D-二聚体含量。结果重复测量方差分析显示，时间因素、时间与分组因素的交互作用和分组因素均有统计学意义。LSD法两两比较显示，与相应时间0h时间点比较，non-UK组仅12h轻度升高，而UK组2、4、6及12h均明显升高（P〈0．05）。相同时间点两组间t检验显示，0h和12h两组间差异无统计学意义；2、4及6hUK组明显高于non-UK组（P〈0．05）。结论脑室内灌注尿激酶能显著升高脑室出血后脑脊液中D-二聚体的含量，提示EVD＋IVIU是治疗重型脑室出血的一种安全、有效方法。Objective To explore the feasibility of intraventricular infusion of urokinase after intraventricular hemorrhage （ IVH）, and to study the effect of intraventricular urokinase on cerebrospinal fluid （CSF） D -dimer after IVH. Methods 34 severe IVH patients were divided into 2 groups： in non - UK group, 17 patients were treated with external ventricular drainage （EVD） alone ; in UK group, another 17 patients were treated with EVD plus intraventricular infusion of urokinase （IVIU）. The CSF D- dimer was measured at 0, 2, 4, 6, 12 h after EVD with ELISA. Results Repeated measures ANOVA results revealed that time factor, time × group, group factor had significant differences. LSD results showed that compared with 0 h point,CSF D -dimer was only slightly increased at 12 h point in non -UK group, but were significantly elevated at 2, 4, 6 and 12 h point in UK group（P 〈0.05）. T test results between groups at the same time point showed that there were no significant differences between two groups at 0 and 12 h point, and CSF D - dimer was significantly higher at 2, 4, 6 h point in UK group than in non- UK group （P 〈 0.05 ）. Conclusions CSF D- dimer is elevated after intraventricular urokinase in severe IVH patients, which suggests that EVD plus IVIU are a safe and effective method to treat severe IVH.

关 键 词：脑室出血(IVH) 尿激酶(UK) D-二聚体 脑室穿刺外引流(EVD) 纤溶 

分 类 号：R743.34[医药卫生—神经病学与精神病学]