Wagner K R, Xi G, Hua Y, Zuccarello M, de Courten-Myers G M, Broderick J P, Brott T G
Department of Neurology, University of Cincinnati College of Medicine, Ohio, USA.
J Neurosurg. 1999 Mar;90(3):491-8. doi: 10.3171/jns.1999.90.3.0491.
Ultra-early hematoma evacuation (< 4 hours) after intracerebral hemorrhage (ICH) may reduce mass effect and edema development and improve outcome. To test this hypothesis, the authors induced lobar hematomas in pigs.
The authors infused 2.5 ml of blood into the frontal cerebral white matter in pigs weighing 8 to 10 kg. In the treatment group, clots were lysed with tissue plasminogen activator ([tPA], 0.3 mg) and aspirated at 3.5 hours after hematoma induction. Brains were frozen in situ at 24 hours post-ICH and hematomal and perihematomal edema volumes were determined on coronal sections by using computer-assisted morphometry. Hematoma evacuation rapidly reduced elevated cerebral tissue pressure from 12.2+/-1.3 to 2.8+/-0.8 mm Hg. At 24 hours, prior clot removal markedly reduced hematoma volumes (0.40+/-0.10 compared with 1.26+/-0.13 cm3, p < 0.005) and perihematomal edema volumes (0.28+/-0.05 compared with 1.46+/-0.24 cm3, p < 0.005), compared with unevacuated control lesions. Furthermore, no Evans blue dye staining of perihematomal edematous white matter was present in brains in which the hematomas had been evacuated, compared with untreated controls.
Hematomas were quickly and easily aspirated after treatment with tPA, resulting in significant reductions in mass effect. Hematoma aspiration after fibrinolysis with tPA enabled removal of the bulk of the hematoma (> 70%), markedly reduced perihematomal edema, and prevented the development of vasogenic edema. These findings in a large-animal model of ICH provide support for clinical trials that include the use of fibrinolytic agents and ultra-early stereotactically guided clot aspiration for treating ICH.
脑出血（ICH）后超早期血肿清除术（<4小时）可能会减轻占位效应和水肿形成，并改善预后。为验证这一假设，作者在猪身上诱导形成脑叶血肿。
作者向体重8至10千克的猪的额叶脑白质内注入2.5毫升血液。在治疗组中，用组织型纤溶酶原激活剂（tPA，0.3毫克）溶解血凝块，并在血肿形成后3.5小时抽吸。脑出血后24小时将大脑原位冷冻，通过计算机辅助形态测量法在冠状切片上测定血肿及血肿周围水肿体积。血肿清除迅速将升高的脑组织压力从12.2±1.3毫米汞柱降至2.8±0.8毫米汞柱。在24小时时，与未清除血肿的对照病变相比，预先清除血凝块显著减少了血肿体积（0.40±0.10立方厘米与1.26±0.13立方厘米相比，p<0.005）和血肿周围水肿体积（0.28±0.05立方厘米与1.46±0.24立方厘米相比，p<0.005）。此外，与未治疗的对照相比，血肿已被清除的大脑中血肿周围水肿性白质没有伊文思蓝染料染色。
用tPA治疗后血肿能快速且容易地被抽吸，导致占位效应显著减轻。用tPA进行纤维蛋白溶解后抽吸血肿能够清除大部分血肿（>70%），显著减少血肿周围水肿，并防止血管源性水肿的形成。脑出血大型动物模型中的这些发现为包括使用纤维蛋白溶解剂和超早期立体定向引导血凝块抽吸术治疗脑出血的临床试验提供了支持。
