经颈动脉溶栓治疗兔脑静脉窦血栓的实验研究

Effects of injecting urokinase via carotid artery in treatment of cerebral venous sinus thrombosis: an experiment with rabbit models

目的研究经颈动脉溶栓治疗对兔脑静脉窦血栓模型的局部脑血流量及脑含水量的影响。方法39只新西兰兔通过结扎法建立兔脑静脉窦血栓模型,分为溶栓组(12只,经颈动脉泵入尿激酶0·4万U·kg-1·d-1,共5d)、抗凝组(12只,颈外静脉泵入肝素2mg·kg-1·d-1,共5d)、对照组(15只,颈动脉泵入生理盐水)。应用激光多普勒仪检测治疗前后局部脑血流量的变化,同时测定脑含水量的变化。结果治疗后局部脑血流量较模型建立前基线的百分率,溶栓组(94·8%±0·3%)明显高于抗凝组(88·6%±0·3%)和对照组(80·9%±0·3%,均P<0·01),抗凝组与对照组比较差异有统计学意义(P<0·01);治疗后溶栓组脑含水量(78·9%±0·3%)低于抗凝组(81·8%±0·7%)和对照组(82·1%±1·0%,均P<0·05)。结论应用颈动脉注射尿激酶栓治疗静脉窦血栓效果肯定,即使治疗不能开通静脉窦,局部脑血流量及脑含水量仍有明显改善。

Objective To study the effects of injection of urokinase via carotid artery in treatment of cerebral venous sinus thrombosis. Methods Thirty-nine New Zealand white rabbits were made into models of cerebral venous sinus thrombosis with the superior sagittal sinus litgated and injected with suspension of cephalin kaolin and cephalin, and then were randomly divided into three groups： control group （n = 15） , anticoagulation group （n= 12, infused with heparin 2 mg · kg^-1 · d^-1 via external carotid venous for 5 days）, and thrombelysis group（n = 12, injected with urokinase 4000 U · kg^-1 · d^-1 via carotid artery for 5 days）. Laser Doppler scanning was used to determine the local cerebral blood flow before ligation, 20 and 90 min after ligation, and at the end of experiment. Five rabbits of the control group per each of the 3 time points （before ligation, 12 h after ligation, and at the end of experiment） were killed to collect the tissues of cerebral cortex in front of the ligated part to determine the brain water content. All the remaining rabbits were killed within 24 hours after the end of experiment to determine the brain water content and undergo microscopy. Results The local cerebral blood flow of the thrombelysis group was 94. 8% ± 0. 3%, significantly higher than those of the anticoagulation group（88.6% ±0.3% ） and control group（80.9% ± 0.3% ） （ both P 〈 0. 01 ）. The brain water content of the thrombelysis group was 78. 9% ± 0. 3%, significantly lower than those of the anticoagulation group （81.8% ± 0.7% ） and control group（82.1% ± 1.0% ）（ both P 〈 0. 05 ）. Conclusion Improving the local blood flow and reducing the brain water content, injection of urokinase via carotid artery is effective in treatment of cerebral venous sinus thrombosis.