ウロキナーゼ髄腔内灌流法 : その基礎と臨床

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In order to make removal of subarachnoid clots safe and swift after aneurysmal early surgery, and thereby to prevent or alleviate cerebral vasospasms, a new irrigation system of the subarachnoid space using a plasminogen activator (urokinase, UK) was devised. After the previous report in 1983, 17 additional patients, amounting to 44 patients in total have been experienced. Furthermore, two basic studies are added. One is measurement of the uptake ratio of radioactive UK into an artificial thrombus formed in a Chandler's tube, and the other is an investigation of an optimal UK concentration, also by the Chandler's tube method. The ratio of radioactivity in the artificial thrombus versus that in the remaining fluid blood was found to attain to 11.03 in 90 minutes; it was 1.4 at the beginning. The thrombus lysing ratio in 6 hours was measured at various concentrations; 25, 30, 50, 100, 150, 300, and 600 IU/ml, respectively. The lysing ratios were found to reach a plateau at 150 IU/ml. The clot lysing effect of this method was studied in the recent patients, with two different ways of investigation. One was measurement of hemoglobin concentration in outlet fluid of the irrigation system by the cyanmethohemoglobin method, and the other was observation of subarachnoid clots by computed tomography (CT). Hemoglobin concentrations in outlet fluid were measured in three kinds of patients; one was 3 patients treated with the ordinary irrigation method (continuous subarachnoid irrigation with 48 IU/ml UK solution for 5-7 days in a dose of 2,000 ml/day); another was one patient treated with a high concentration UK pooling method (pooling of 10 ml of 1,200 IU/ml UK solution in the subarachnoid space for 6 hours with the interruption of the ordinary UK irrigation); and the other was one patient treated with physiological saline solution only. Hemoglobin concentrations in outlet fluid were found to be much higher in the patients treated with UK irrigation, especially in the patient treated with the high concentration UK pooling, than in the patient irrigated with physiological saline solution only. Sequential CT findings of 4 recent representative patients are shown. On CT, high densities in the perimesencephalic cistern were recognized to have disappeared within 7 days in the patients treated with UK irrigation, while they were still observed in the control patients. In one patient who was treated with UK irrigation combined with the high concentration UK pooling, high density in the insular cistern was found to have disappeared in 4 days.
社団法人日本脳神経外科学会の論文
1985-12-15

ウロキナーゼ髄腔内灌流法 : その基礎と臨床

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