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摘要
Perihematomal edema (PHE) can worsen patient outcomes after spontaneous intracerebral hemorrhage (ICH). Minimally invasive surgery (MIS) in combination with thrombolytic removal of hematoma has been proven to be a promising treatment strategy. However, preclinical studies have suggested that intraclot thrombolysis may exacerbate PHE after ICH. Herein, we investigated the effects of MIS and urokinase on PHE. @@@ ICH patients were retrospectively identified from our institutional ICH database. Computerized volumetric analysis was applied to assess changes in both ICH and PHE volumes using computed tomographic (CT) scans of T-1 (pre-MIS) and T-2 (post-MIS) time points. Relative PHE (rPHE) was calculated as a ratio of PHE and T-1 ICH volume. @@@ Data from 60 MIS plus urokinase (MIS + U), 20 MIS aspiration only (MO), and 30 control patients were analyzed. The ICH volume, PHE volume and rPHE on T-2 CT in both MIS + U and MO groups significantly decreased as compared with the control group (ICH volume, 13.7 +/- 5.7 ml, 17.0 +/- 10.5 ml vs. 30.5 +/- 10.3 ml, P < 0.01; PHE volume, 36.5 +/- 18.9 ml, 32.2 +/- 17.5 ml vs. 45.4 +/- 16.0 ml, P < 0.01; rPHE, 0.9 +/- 0.4, 0.8 +/- 0.4 vs.1.4 +/- 0.5, P < 0.01). Between the MIS + U and MO groups, the ICH volume, PHE volume and rPHE at T-2 trended towards similarity, but was not significant (P = 0.09, P = 0.40, P = 0.43). Furthermore, we found a significant correlation between the percent of ICH removal and PHE reduction (r = 0.59, P < 0.01). There was no correlation between the cumulative dose of urokinase and either T-2 PHE volume (r = 0.19; P = 0.16) or T-2 rPHE (r = -0.12; P = 0.37). @@@ Hematoma evacuation using MIS leads to a significant reduction in PHE. Furthermore, the use of urokinase does not exacerbate PHE, making its hypothesized proedematous effects unlikely when the thrombolytic is administered directly into the clot.
- 出版日期2014-9
- 单位华中科技大学
