Deinsberger W, Vogel J, Fuchs C, Auer L M, Kuschinsky W, Böker D K
Neurosurgical Clinic, Justus-Liebig University Giessen, Germany.
Neurol Res. 1999 Jul;21(5):517-23.
The hypothesis was tested in rats that brain ischemia by an intracerebral hematoma can be ameliorated by fibrinolysis and aspiration of the hematoma. Intraparenchymal blood clots were generated by the injection of 50 microliters of autologous blood into the right caudate nucleus in two portions seven minutes apart. Thirty or 120 min later 12 microliters recombinant tissue plasminogen activator (rtPA) or 0.9% NaCl were injected and after 30 min the resolved hematoma was aspirated. Six hours later cerebral blood flow (CBF) was determined by 14C-iodoantipyrine autoradiography. Tissue volumes of CBF < 10 ml 100 g-1 min-1 and CBF < 30 ml g-1 min-1 were determined. Clot and lesion volume were quantified histologically from serial sections stained for succinate-dehydrogenase (SDH) activity. In rtPA-treated rats the major part of the hematoma could be evacuated 30 min as well as 120 min after production of the clot. The volume of ischemic brain (CBF < 10) was significantly reduced (p < 0.05) in the rtPA group compared to saline-treated and control groups irrespective of the time of treatment. In contrast, no difference was found between the control group and the experimental groups when the volumes of brain tissue surrounding the lesion were compared which had values of CBF < 30 ml 100 g-1 min-1. In a rat model of intracerebral hemorrhage, treatment by local fibrinolysis followed by aspiration of the hematoma is effective in reducing the volume of ischemic brain tissue and of the remaining clot volume.
脑内血肿所致的脑缺血可通过纤溶和血肿抽吸得到改善。通过将50微升自体血分两部分、间隔7分钟注入右侧尾状核来形成脑实质内血凝块。30或120分钟后，注入12微升重组组织型纤溶酶原激活剂（rtPA）或0.9%氯化钠溶液，30分钟后将溶解的血肿吸出。6小时后，通过14C-碘安替比林放射自显影术测定脑血流量（CBF）。测定CBF<10 ml 100 g-1 min-1和CBF<30 ml g-1 min-1时的组织体积。通过对琥珀酸脱氢酶（SDH）活性染色的连续切片进行组织学定量分析血凝块和病变体积。在rtPA治疗的大鼠中，血凝块形成后30分钟和120分钟时，大部分血肿均可被吸出。与盐水治疗组和对照组相比，rtPA组缺血性脑体积（CBF<l0）显著减小（p<0.05），且与治疗时间无关。相比之下，当比较病变周围CBF<30 ml 100 g-1 min-1的脑组织体积时，对照组与实验组之间未发现差异。在脑出血大鼠模型中，局部纤溶后抽吸血肿的治疗方法可有效减少缺血性脑组织体积和剩余血凝块体积。
