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《Neural Injury and Functional Reconstruction》 2018-03
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Preliminary Study of Minimally Invasive Intracranial Hematoma Evacuation Surgery Combined with rt-PA in Patients with Spontaneous Intracerebral Hemorrhage

LIAN Li-fei;XU Feng;LIANG Qi-ming;ZHU Wen-hao;PAN Chao;WANG Gang;ZHANG Yi-chi;Wang Fu-rong;TANG Zhou-ping;ZHU Sui-qiang;Department of Neurology, Tongji Hospital, Tongji Medical College,Huazhong University of Science and Technology;  
Objective: 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 rtPA. 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(m RS) was used for scoring clinical outcomes(m RS 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 was0, significantly lower than the predicted mortality(46.7%). No patients developed intracranial infection, and only2 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(m RS 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.
【Fund】: 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
【CateGory Index】: R651.1
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