Mayfrank L, Kim Y, Kissler J, Delsing P, Gilsbach J M, Schröder J M, Weis J
Neurochirurgische Klinik, Universitätsklinikum der RWTH Aachen, Germany.
Acta Neuropathol. 2000 Nov;100(5):561-7. doi: 10.1007/s004010000219.
Intraventricular haemorrhage (IVH) occurs in up to 50% of patients with primary intracerebral haemorrhage and aneurysmal subarachnoid haemorrhage. It is a significant and independent contributor to mortality and morbidity in these intracranial haemorrhages. Using a model of isolated IVH, we assessed the morphological changes induced by intraventricular bleeding and investigated the effects of intraventricular fibrinolytic treatment following IVH. IVH was induced in 32 pigs by intraventricular infusion of 10 ml autologous blood along with thrombin. The treatment group received an intraventricular injection of 1.5 mg (1 mg/ml) tissue plasminogen activator (tPA) following the injection of blood. The placebo group received the same volume of normal saline. Morphological examinations of the brains were carried out 7 days and 6 weeks following IVH. The ventricles were incompletely filled with blood and significantly enlarged in the placebo group 7 days after the IVH. In contrast, no residual intraventricular clots were visible in the animals treated with tPA, and the diameters of the lateral ventricles had returned to normal within 7 days. Marked losses of the ependymal covering of the ventricular walls were found in the placebo-treated animals, while the ependymal layer was largely intact in the animals treated with tPA. No haemorrhages induced by tPA were observed. The results indicate that intraventricularly administered tPA significantly enhances the lysis of intraventricular blood clots, accelerates the resolution of acute posthaemorrhagic hydrocephalus, and preserves the integrity of the ependymal layer.
脑室内出血（IVH）在高达50%的原发性脑出血和动脉瘤性蛛网膜下腔出血患者中发生。它是这些颅内出血死亡率和发病率的一个重要且独立的影响因素。我们使用孤立性IVH模型，评估脑室内出血引起的形态学变化，并研究IVH后脑室内纤溶治疗的效果。通过向32头猪脑室内注入10 ml自体血加凝血酶诱导IVH。治疗组在注入血液后接受脑室内注射1.5 mg（1 mg/ml）组织型纤溶酶原激活剂（tPA）。安慰剂组接受相同体积的生理盐水。在IVH后7天和6周对大脑进行形态学检查。IVH后7天，安慰剂组脑室内血液未完全充满且脑室明显扩大。相比之下，tPA治疗的动物未见脑室内残留血凝块，侧脑室直径在7天内恢复正常。在接受安慰剂治疗的动物中发现脑室壁室管膜覆盖层明显缺失，而tPA治疗的动物室管膜层基本完整。未观察到tPA引起的出血。结果表明，脑室内给予tPA可显著增强脑室内血凝块的溶解，加速急性出血后脑积水的消退，并保持室管膜层的完整性。
