Cisternal irrigation therapy with urokinase and ascorbic acid for prevention of vasospasm after aneurysmal subarachnoid hemorrhage. Outcome in 217 patients.

摘要: Abstract BACKGROUND Cisternal irrigation therapy with urokinase and ascorbic acid was introduced to prevent symptomatic vasospasm after aneurysmal subarachnoid hemorrhage (SAH). To dissolve wash out the clot, cisternal is used. Ascorbic added degenerate oxy-hemoglobin, one of strongest spasmogenic substances, into verdohemelike products, which are nonspasmogenic. The efficacy safety this were evaluated. METHODS This performed consecutively in 217 patients. degree SAH patients classified as Fisher CT Group 3, highest number (Hounsfield number) exceeded 60 SAH, suggested a significant risk for vasospasm. All underwent surgery within 72 hours from onset SAH. After clipping aneurysm, tubes placed Sylvian fissure (inlet) unilaterally or bilaterally prepontine chiasmal cistern (outlet). Lactated Ringer’s solution (120 IU/mL) (4 mg/mL) infused at rate 30 mL/hour/side approximately 10 days. RESULTS Of studied, observed 6 cases (2.8%), two these six (0.9%) demonstrated sequelae. average total blood volume calculated drainage fluid 114 mL. Analysis absorption spectrum revealed disappearance oxy-hemoglobin-specific 576-nm peak. Complications occurred eight during therapy; experienced seizures, developed meningitis, four had an intracranial hemorrhage. However, all recovered without neurological deficits. CONCLUSIONS These results suggest that effective preventing