替罗非班联合尿激酶超选择动脉溶栓治疗急性大脑中动脉栓塞的实验研究

Experimental Study on Intra-Arterial Thrombolysis with Tirofiban Combined with Urokinase in the Middle Cerebral Artery Occlusion

目的:探讨替罗非班联合尿激酶超选择性溶栓治疗急性大脑中动脉栓塞的疗效和安全性。方法:采用兔自体血栓栓塞大脑中动脉制成急性脑梗死模型,随机分为替罗非班组(T组)、尿激酶组(UK组)、替罗非班+尿激酶组(T+UK组)和对照组。采用X线数字减影(DSA)观察动脉内超选择溶栓的血管再通率,磁共振弥散成像观察相对表观弥散系数(rADC),改良Bederson评分法观察神经功能缺损。24h后处死动物,经氯化-2,3,5-三苯基四氯唑染色,进行光镜病理形态学检查。结果:T+UK组血管再通率为80%,病理检查未见明显出血,rADC值、神经功能缺损评分、脑梗死面积均优于T组、UK组和对照组。结论:早期使用替罗非班联合尿激酶进行动脉内溶栓在兔超早期脑缺血模型中疗效优于单纯尿激酶动脉内溶栓。

Objective：To investigate the efficacy and safety of intra-arterial thrombolytic treatment with tirofiban and urokinase in rabbit model of middle cerebral artery occlusion（MCAO）. Methods：The model of middle cerebral artery occlusion was established in New Zealand rabbit by autologous clot. The MCAO rabbits were randomly divided into thrombolysis with tirofiban group （T group）, thrombolysis with urokinase group （UK group）, thrombolysis with tirofiban combined with urokinase group （T＋UK group） and control group （C group）. The recanalization rate detected by X-ray digital subtraction angiography （DSA）, relative-apparent diffusion coefficient （rADC） and the neurological deficit score （Bederson） were compared between groups. Rabbits were killed after 24 h of MCAO. The pathological changes were detected by 2,3,5-triphenyltetrazolium chloride （TTC） staining. Results：The repatency rate was 80% in T＋UK group. The values of rADC, the neurological deficit score and infarction area were better in T＋UK group than those of T group, UK group and control group. Conclusion：At the early stage after MCAO, the efficacy of thrombolytic treatment with tirofiban and urokinase was better than that with single urokinase.