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 pneurmonia. In 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 trid high dose UK irrigation (group II : irrigation with 50ml 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 (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%, respectively). One case (5%) of postoperative rebleeding was noted in group II.
From this study, we concluded that, even if the beneficial affects are small, the high dose UK irrigation is one of protocols in the management of hypertensive ICH patients.
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