微创术后血肿内应用重组组织型纤溶酶原激活剂对脑出血后癫痫发作的影响  

Effect of minimally invasive surgery combined with intraclot rt-PA on seizures in patients with spontaneous intracerebral hemorrhage

作　　者：连立飞[1] 梁钧昱 许峰[1] 梁奇明[1] 潘超[1] 叶晓东 王芙蓉 朱遂强[1] LIAN Li-fei;L;XU Feng;LIANG Qi-ming;PAN Chao;YE Xiao-dong;WANG Furong;ZHU Sui-qiang(Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院,武汉430030

出　　处：《内科急危重症杂志》2018年第4期272-274,共3页Journal of Critical Care In Internal Medicine

基　　金：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(No:2012-1-03);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项目(No:5001540009)

摘　　要：目的:评估微创术治疗脑出血时血肿腔内局部应用重组组织型纤溶酶原激活剂(rt-PA)对癫痫发作的作用及影响癫痫发作的危险因素。方法:收集接受微创术联合rt-PA治疗、且术前无癫痫发作的幕上自发性脑出血患者的临床和影像学资料并随访,采用改良Rankin量表评估预后。结果:共纳入181例患者,男118例;平均发病年龄(53. 3±11. 1)岁,术前平均血肿体积(39. 1±19. 3) m L,rt-PA的中位用药次数和量分别为2次和2. 0 mg,治疗结束时平均血肿清除率为82. 5%±12. 1%。中位数随访24月,19例(10. 5%)出现癫痫发作,其中89. 5%的发作发生在脑出血后1年内。回归分析发现影响癫痫发作的因素是出血累及皮层(OR 2. 90,95%CI 1. 60～4. 29,P <0. 001)和血肿体积(OR 1. 30,95%CI 1. 10～2. 82,P <0. 001)。癫痫组与非癫痫组患者预后比较差异无统计学意义(21. 1%vs39. 5%,P> 0. 05)。结论:微创术联合小剂量rt-PA治疗幕上自发性脑出血安全、有效,血肿腔内应用rt-PA不加重脑出血后的癫痫发作,出血累及皮层和血肿体积是影响癫痫发作的主要危险因素。Objective： To test the effect of minimally invasive surgery（ MIS） plus intraclot use of recombinant tissuetype plasminogen activator（ rt-PA） on seizures in patients with spontaneous supratentorial intracerebral hemorrhage（ ICH）and to explore the potential risk factors for seizures in this context. Methods： Patients without any prior diagnosis of epilepsy treated with MIS and intraclot rt-PA were collected. Clinical outcomes were scored using the modified Rankin Scale and seizures were evaluated. Results： 181 patients were included in the study,118 were male,and mean age was 53. 3 ± 11. 1 years. The hematoma was（ 39. 1 ± 19. 3） m L,and the median number and dosage of intraclot rt-PA were 2 and 2. 0 mg,respectively. Mean 82. 5% ± 12. 1% of clot was removed. During median 24 months of follow-up,19 patients（ 10. 5%） experienced seizures and the mean delay between ICH and seizures was 6 months. The factors independently associated with the occurrence of seizures were a cortical involvement of the ICH（ OR 2. 90,95% CI 1. 60-4. 29,P 〈0. 001） and hematoma volume（ OR 1. 30,95% CI 1. 10-2. 82,P 〈0. 001）. Seizures were not associated with a worse functional outcome（ 21. 1%vs 39. 5%,P〈0. 05）. Conclusions： MIS combined with low dose of rt-PA for hematoma evacuation seems to be safe and can effectively remove clot in patients with spontaneous supratentorial ICH. The intraclot use of rt-PA has no effect on seizures under such a circumstance. The risk factors for seizures are cortical involvement of the ICH and large hematoma size.

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 癫痫发作 

分 类 号：R743.34[医药卫生—神经病学与精神病学]