经侧脑室短期重复应用重组链激酶预防家猪迟发性脑血管痉挛

Prevention Pigs from Delayed Cerebral Vasospasm after Subarachnoid Hemorrhage by Repeated Injections of Recombinant Streptokinase into Lateral Ventricle

目的 观察重组链激酶 (r SK)经侧脑室给药 ,预防蛛网膜下腔出血 (SAH)后迟发性脑血管痉挛 (DCV)的作用。方法 选取家猪 12头 ,随机均分成SAH对照组和r SK治疗组 ,经腰穿枕大池置管 2次注血法制作SAH动物模型 ;第 2次注备后 2 4h ,治疗组经侧脑室在 2 4h内 ,连续 3次注入r SK ,5mg/次 ,对照组注入生理盐水 ;两组均经腰穿留置管行脑脊液 (CSF)引流 ,并测定CSF中氧合血红蛋白 (OxyHb)含量 ;以实验前后脑血管造影和基底动脉 (BA)组织学改变作为脑血管痉挛的判定指标。结果 对照组双侧颈内动脉 (ICA)和BA明显痉挛(P <0 .0 1) ;BA电镜和组织切片检查有内膜增生、内褶、弹力层断裂等病理改变 ;OxyHb随时间逐渐升高。治疗组总体血管直径变化无显著性差异 (P >0 .0 5 ) ;BA均正常 ;OxyHb随时间逐渐降低。结论 经侧脑室短期重复给予r SK并CSF引流 ,有较好的预防SAH后DCV的作用。

Purpose: To prevent pigs from delayed cerebral vasospasm (DCV) by repeated injections of recombinant streptokinase (r-SK) into lateral ventricle after subarchnoid hemorrhage (SAH). Methods: Twelve pigs weighing between 10 and 12 kg were randomly divided equally into SAH control and r-SK treatment groups. After initial angiography of internal cervical artery (ICA), SAH were produced by two times injections of arterial blood into cisterna magna via a catheter inserted through lumbar puncture. For each pig of the r-SK group 5 mg r-SK was administered three times into lateral ventricle within 24 hours through a tube after 24 hours second blood injection, while saline was administered for the control group at same time. 1 to 2 mL cerebral spinal flood (CSF) was drained from the catheter separately at 6,12 hours and 1,3,5,6 days after r-SK or saline used,and oxyhemoglobin (Oxy Hb) in CSF at 1,3,5,6 days was measured also. On 6 days after r-SK or saline administered, second angiorgrams of ICA were performed and basal arteries samples were observed in light microscope and transmission electron microscope from each pig. Results: On second angiography severe vasospasm of bilateral ICA and BA were developed in all pigs of SAH control group P 0.05). Typical proliferative vasculopathy of BA were found in all pigs of SAH control group at histological examination whereas no changes occurred in ones of the r-SK groups. Oxy Hb in CSF of the control group were increased by tilmes while decreased in the r-SK group. Conclusions: Repeated injections of r-SK into lateral ventricle and CSF drainage was a good method for prevention from delayed cerebral vasospasm after SAH.