重组组织纤溶酶原激活物预防蛛网膜下腔出血后迟发性脑血管痉挛的实验研究

Prevention of delayed cerebral vasospasm after experimental subarachnoid hemorrhage with intracisternal injection of r-TPA

目的 实验研究重组组织纤溶酶原激活物预防蛛网膜下腔出血后迟发性脑血管痉挛(DVS)。方法实验选取 12只家犬 ,随机分成两组。采取“两次出血法”制成蛛网膜下腔出血 (SAH)模型。SAH前先做基底动脉造影 ,然后行枕大池穿刺 ,抽出脑脊液 4ml后注入等量自体动脉血。第一次“SAH”后 48小时再次注入自体动脉血 4ml。第二次注血后 6小时治疗组 6只动物经枕大池穿刺注入组织型纤维蛋白溶解酶原激活物 (r TPA) 2 5mg ;对照组注入生理盐水。 7天后再次行基底动脉造影。结果 动脉造影r TPA治疗组基底动脉口径无明显变化 (P >0 0 5 ) ;解剖除 1例基底动脉外膜上可见数点凝血外 ,其余动物颅底均无血块。对照组两次动脉造影基底动脉缩小极为明显 (P <0 0 1) ,有严重的血管痉挛。颅底充满血块 ,基底动脉被血块所包绕。结论 r TPA能充分地溶解未成熟的(SAH后 48小时 )蛛网膜下腔凝血块 ,从而有效的预防迟发性脑血管痉挛的出现。

Objective To study the for prevention of DVS after SAH with injection of r TPA. Methods 12 dogs were randomly assigned equally into 2 groups, SAH were created with “double hemorrhage model”. 2 days later(48 hours after the first and 6 hours after the second injection of blood), 25μg r TPA (dissolved in 1ml physiological saline) was injected into the cisternal magna in treatment group, and 1ml physiological saline was injected into the cisternal magna in the control group. Before“hemorrhage”and 7 days after the“SAH”, angiograms of the left vertebral basilar arteries were taken. Results The angiography showed that spasm of the basilar arteries were completely prevented in all of treated group, whereas, in the control group severe vasospasm occurred. Inspection of the base of brain demonstrated that subarachnoid blood clots were nearly completely disappeared in treated group. While basilar arteries were embedded in the thick subarachnoid clots in control group.Conclusions Intracisteral injection r TPA can resolve the premature blood clots and prevent vasospasm effectively within 48 hours after SAH.