고혈압성 뇌실질내 혈종치료에서 고용량 Urokinase관주법

Abstract

It is well known that stereotaxic urokinase(UK) irrigation through a catheter is one of surgical methods in the management of hypertensive intracerebral hematoma(ICH) patients. Several authors recommended irrigation with 6000 IU UK, 4 times per a day. Based on authors' experience some patients who were managed with above protocol suffered from complications such as meningitis and/or pneumonia. It might be partially caused by prolonged duration of irrigation and immobilization of the patients. In order to reduce complications and to improve the final outcome of hypertensive ICH patients we tried high dose UK irrigation(group Ⅱ irrigation with 50㎖ of normal saline mixed with 200,000 IU UK at immediate postoperative period, followed by two times of 20,000 IU UK irrigation per a day) to remove the ICH rapidly in those patients since Oct 1991. We compared the rate of decreasing volume of hematoma. Glasgow coma scale(GCS) score change according to postoperative period final outcome, and the rate of complications between this group(group Ⅱ) and group Ⅰ(4 times irrigation with 6,000 IU UK per a day). The result shows that the rate of decreasing volume of hematoma is slightly more rapid in group Ⅱ than group Ⅰ. The rate of poor outcome(vegetative and death) is lower in group Ⅱ than Ⅰ(group Ⅰ vs. Ⅱ 34% vs. 20% respectively). The rate of complication is lower in group Ⅱ than Ⅰ(group Ⅰ vs. Ⅱ : 38.5 '% vs. 20.0 46, respectively). One case(5 % of postoperative rebleeding was noted in group Ⅱ. From this study, we concluded that even if the beneficial effects are small, the high dose UK irrigation is one of protocols in the management of hypertensive ICH patients.