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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。
Objective: To observe the short-term repeated administration of recombinant human streptokinase (r SK) through the lateral ventricle and drainage of cerebrospinal fluid (CSF) to prevent delayed cerebral vasospasm (DCV) after ruptured subarachnoid hemorrhage (SAH) in cerebral aneurysms. Methods: Fourteen cases of Fisher Grade 3 patients with ruptured cerebral aneurysms were treated with tumor neck embolization or tumor embolization within 72 hours, and lateral cerebral ventricle drainage. The patients were divided into treatment group and control group, with 7 cases in each group. The treatment group was injected r TS 5 mg · d-1 into the lateral ventricle for 2 ~ 3d consecutively. Postoperative delayed neurological deficits were diagnosed as DCV; 1 to 3 months after surgery to assess the prognosis of GOS. Results: The SAH blood clot in the treatment group disappeared 3 ~ 4 days after operation, and no DCV occurred. The GOS scores were all 5 points. In the control group, the blood clot disappeared 4 to 10 days after operation and no DCV occurred in 3 cases. The GOS score was 5 points. In 4 cases of DCV, 2 cases had 4 points for GOS, 1 case for 3 points and 1 point. Conclusion: Short-term repeated application of r SK in the lateral ventricle has good curative effect on DCV after SAH.