脑出血微创抽吸术联用单唾液酸四己糖神经节苷脂对大鼠脑水肿的影响

Experimental study on effect of minimally invasive hematoma aspiration combined with monosialoganglioside on cerebral edema

目的:探讨实验性脑出血微创抽吸术联合腹腔、血肿腔应用单唾液酸四己糖神经节苷脂(monosialoganglioside,GM1)对脑出血急性期脑水肿的影响。方法:将Ⅳ型胶原酶注入SD大鼠尾状核诱导形成脑出血10h后,向血肿腔内注入尿激酶溶解血凝块,实施微创血肿抽吸术排出脑内血肿,通过对抽吸组与抽吸腹腔给药组及抽吸血肿腔给药组之间的脑组织含水量测定,不同时间脑组织水通道蛋白4(Aquaporin-4,AQP4)免疫组化检测,对微创抽吸术联合2种途径应用GM1治疗脑水肿的疗效进行评估。结果:抽吸血肿腔给药组,抽吸腹腔给药组注胶原酶3d的脑组织含水量明显少于抽吸组(P<0.05),注酶3d时间点血肿周围AQP4表达细胞数和累积光密度值小于抽吸组(P<0.05),5,7dAQP4表达细胞数和累积光密度值减少明显(P<0.01)。结论:大鼠脑出血微创抽吸术联合腹腔、血肿腔应用GM1治疗能减轻脑出血急性期脑水肿,AQP4参与脑水肿形成,而且可能是GM1减轻脑水肿的潜在靶点;微创血肿抽吸血肿腔给药用药量更少,脑出血治疗更经济。

ORIECTIVE To study the effect of minimally invasive hematoma aspiration combined with monosialoganglioside （GM1） injected into peritoneal and hematoma intracavity on cerebral edema of acute stage originated by intracerebral hemorrhage. METHODS Intracerebral hemorrhage was induced by injecting Ⅳ collagenase into caudate nucleus of SD rats, and after ten hours urokinase was injected into hematoma intracavity to dissolve clot. Hematoma was removed from intracavity by use of minimally invasive hematoma aspiration. The effect of minimally invasive hematorna aspiration combined with monosialoganglioside（GM1） on cerebral edema was evaluated by determination of brain water and immunohistochemical of AQP4 in brain tissue during different time, among aspiration group, aspiration combined with GM1 peritoneal injection group and aspiration combined with GM1 hematoma cavity injection. RESULTS Brain water of aspiration combined with GM1 peritoneal injection group and aspiration combined with GM1 hematoma cavity injection, were less than that of aspiration group （P〈0. 05） and the number of cells and integrated optical density expressed AQP4 around hematoma on third day were smaller（P〈0. 05）, there was significant decrease in the number of cells and integrated optical density on fifth and seventh day（P〈0. 01）. CONCLUSION Minireally invasive hematoma aspiration combined with GM1 helps to reduce cerebral edema of acute stage originated by intracerebral hemorrhage in rats; AQP4 participates formation of cerebral edema; furthermore, AQP4 might be potential target that GM1 reduces cerebral edema. Medication dosage of minimal invasive hematoma aspiration combined with GM1 hematoma cavity injection, was less and more economical in treatment of intracerebral hemorrhage.