不同时机行微创血肿抽吸术治疗大鼠脑出血的研究

Minimally invasive aspiration for intracerebral hematoma in rats at different operative timings

目的 观察在不同手术时机行微创血肿抽吸术治疗大鼠脑出血后，神经功能缺损、超氧化物歧化酶（SOD）、丙二醛（MDA）的变化情况。探讨微创血肿抽吸术治疗脑出血的作用机制及最佳手术时机。方法将96只SD大鼠随机分为对照组、脑出血组、3h和6h血肿抽吸组，每组24只。采用自体血50ml注入大鼠尾状核内制备脑出血模型，并进行脑出血模型成功的评价，在脑出血组和血肿抽吸组大鼠脑内血肿中心血肿注入1000U尿激酶溶解血肿，对两个血肿抽吸组于脑出血后3h和6h，抽吸出部分血肿（血肿总量的50％）；对照组注入等量等渗盐水。于1、3、5、7、10、14d分别评价神经功能，黄嘌呤氧化酶法测定脑组织SOD活性，硫代巴比妥酸法测定MDA含量。结果与脑出血组比较，血肿抽吸组（3h和6h）神经功能缺损评分、SOD活性均增高（P〈0．05）；而MDA水平则下降（P〈0．05）。并且3h血肿抽吸组的治疗效果要优于6h血肿抽吸组。结论微创血肿抽吸术治疗脑出血的效果与手术时机的选择密切相关，进行手术治疗的时问越早效果越好。

Objectives To observe the changes of neurological dysfunction, superoxide dismutase （SOD） and malondialdebyde （MDA） after minimally invasive hematoma aspiration in the treatment of intra- cerebral hemorrhage （ICH） in rats at different operation timings, and to investigate the mechanism and the optimal operation timings for hematoma aspiration. Methods Ninety-six Sprague-Dawley rats were randomly allocated into control, ICH, operation of at 3-hour and at six-hour operation groups （n = 24 in each group）. ICH models were induced by infusing autologous blood into the caudate-putamen region. Urokinase was injected to the center of intracerebral hematoma to dissolve the hematoma in part of the ICH models, and the hematoma was aspirated at 3 or 6 hours after ICH. The equivalence saline was injected in the control group. The criteria of Bederson et al were used to determine the neurological dysfunction at day 1, 3, 5, 7, 10, and 14, respectively. The xanthine oxidase method was used to detect the activities of superoxide dismutase （ SOD）, and the thiobarbituric acid method was used to measure the content of MDA. Results Compared with the ICH group, both the neurological dysfunction scores and the activities of SOD were increased in the 3- and 6-hour operation groups （ P 〈 0.05 ）, while the content of MDA was decreased （ P 〈 0.05 ）. And the therapeutic efficacy of the 3-hour operation group was superior to that of the 6-hour operation group. Conclusion The efficacy of minimally invasive henmtoma aspiration in the treatment of ICH is closely correlated with the operation timings, the earlier the operation the better the effect. This experiment has provided a theoretical basis for the minimally invasive treatment of [CH in clinical practice.