• Hiệu quả của biện pháp tiêu sợi huyết não thất bằng alteplase (rt-PA) trong điều trị chảy máu não thất

      Tiêu sợi huyết não thất là kỹ thuật sử dụng thuốc tiêu sợi huyết (rt-PA) bơm vào não thất qua dẫn lưu não thất để làm tiêu nhanh máu đông trong não thất (đặc biệt là não thất 3 và não thất 4), tạo thuận làm thông sớm hệ thống não thất phía dưới và từ đó tránh được biến chứng giãn não thất



      Báo cáo khoa học trong Hội nghị Quốc tế về Y học Cấp cứu 2015. Ảnh: LQC

      HIỆU QUẢ CỦA BIỆN PHÁP TIÊU
      SỢI HUYẾT NÃO THẤT BẰNG ALTEPLASE (rt-PA) TRONG ĐIỀU TRỊ CHẢY MÁU NÃO THẤT

      ThS. BS. Lương Quốc Chính
      Khoa Cấp cứu,
      Bệnh viện Bạch Mai

      TÓM TẮT

      Nghiên cứu thực hiện trên 41 bệnh nhân chảy máu não thất có giãn não thất cấp đã được dẫn lưu não thất ra ngoài tại khoa Cấp cứu, bệnh viện Bạch Mai từ tháng 8/2012 đến 2/2014 nhằm đánh giá hiệu quả của tiêu sợi huyết bằng alteplase (rt-PA) trong điều trị chảy máu não thất có giãn não thất cấp. Bệnh nhân nghiên cứu được chia 2 nhóm không ngẫu nhiên: nhóm không sử dụng thuốc tiêu sợi huyết (nhóm chứng, n=21) và nhóm có sử dụng thuốc tiêu sợi huyết (nhóm can thiệp, n=20). Kết quả tốt (khi mRS = 0 – 3 và GOS = 3 - 5) tại thời điểm 1 tháng ở nhóm chứng (19,0% và 52,4%) thấp hơn nhóm can thiệp (30,0% và 75%), với p >0,05; và tại thời điểm 3 tháng ở nhóm chứng (57,1% và 85,7%) thấp hơn nhóm can thiệp (58,8% và 100%). Tỷ lệ tử vong ở nhóm chứng (33,3%) cao hơn so với nhóm can thiệp (15%), với p > 0,05. Không thấy sự khác biệt về các biến chứng giữa hai nhóm bao gồm tiến triển máu tụ nhu mô não (14,3% so với 10,0%, p > 0,05), chảy máu não xung quanh dẫn lưu (9,5% so với 15,0%, p > 0,05), tắc dẫn lưu não thất (14,3% so với 5,0%, p > 0,05), viêm não thất (4,8% so với 10,0%, p > 0,05) và giãn não thất mạn tính (9,5% so với 5,0%, p > 0,05). Kết quả này cho thấy tiêu sợi huyết bằng alteplase (rt-PA) trong điều trị chảy máu não thất có xu hướng làm cải thiện kết quả điều trị và tỷ lệ tử vong nhưng sự khác biệt chưa đủ độ mạnh có ý nghĩa thống kê (sự hạn chế này có thể do cỡ mẫu nhỏ, chưa đủ độ tin cậy để đánh giá thống kê).

      Từ khóa: Xuất huyết não, Chảy máu não thất, Giãn não thất thể tắc nghẽn, Tiêu sợi huyết não thất, Alteplase (rt-PA)

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      Effectiveness of Thrombolytic Therapy by Alteplase (rt-PA) on the Treatment of Intraventricular Hemorrhage

      A study on 41 patient admitted to Emergency Department of Bach Mai Hospital due to intraventricular hemorrhge with acute dilatation who were undergone ventriculostomy to drain CSF externally at Emergency Department of Bach Mai Hospital from 8/2012 to 2/2014 aims at to evaluate the effectiveness of thrombolytic therapy by alteplase (rt-PA) in the treatment of intraventricular hemorrhage with acute ventricular dilatation. Patients were unrandomly selected in to 2 groups: without alteplase (rt-PA) (control, n=21) and with alteplase (rt-PA) (interventional group, n=20). A good result (mRS = 0 – 3 and GOS = 3 - 5) at 1 month in control group was (19% and 52.4%) lower than those in interventional group (30.0% and 75%), p > 0,05; at 3 month in control group (57.1% and 85.7%) was lower than those in interventional group (58.8% and 100%). Mortality in control group (33.3%) was higher than those of interventional group (15%), p > 0.05. there was no difference in complication between group in intracerebral hematoma progression (14.3% vesus 10.0%, p > 0.05), bleeding around the catheter (9.5% vs 15.0%, p > 0.05), cetheter occlusion (14.3% vs. 5.0%, p > 0.05), ventriculitis (4.8% vesus 10.0%, p > 0.05) chronic ventricular dilatation (9.5% vesus 5.0%, p > 0.05). Our results showed that thrombolytic therapy by alteplase (rt-PA) in the treatment of intraventricular hemorrhage seem to improve outcomes and motality rate, however, the statistic power was still not strong enough (due to small study population, statistic reliability).

      Keywword: Intracranial Hemorrhage, Intraintraventricular hemorrhage, Obstructive Hydrocephalus, Intraventricular Thrombolysis, Alteplase (rt-PA)

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