Thiex Ruth
Department of Neurosurgery, Aachen University, Aachen, Germany.
Cent Nerv Syst Agents Med Chem. 2011 Jun 1;11(2):150-6. doi: 10.2174/187152411796011367.
Intracerebral hemorrhage (ICH) is associated with a high mortality and severe disability. Whereas a classical open craniotomy for hematoma removal may further traumatize brain tissue, minimally invasive surgery combines benefits of surgical clot removal with limited tissue damage and shorter surgery duration. Evacuation is often hampered by clot retraction, thus, advocating clot liquefaction to facilitate complete evacuation. The use of urokinase or recombinant tissue plasminogen activator (rtPA) alone and in combination with neuroprotective drugs in experimental studies and clinical trials is reviewed with respect to efficacy in hematoma reduction and effects on secondary brain injury. Whereas rtPA promotes delayed edema formation and inflammation after local fibrinolysis, desmoteplase (DSPA), a highly fibrin-selective plasminogen activator derived from vampire bat saliva, combines high fibrinolytic potential with lack of excitotoxicity, thus representing a novel, promising candidate for fibrinolytic therapy of ICH.
脑出血（ICH）与高死亡率和严重残疾相关。传统的开颅血肿清除术可能会进一步损伤脑组织，而微创手术则将手术清除血凝块的益处与有限的组织损伤和更短的手术时间相结合。血凝块回缩常常阻碍血肿清除，因此，提倡通过使血凝块液化来促进彻底清除。本文综述了在实验研究和临床试验中单独使用尿激酶或重组组织型纤溶酶原激活剂（rtPA）以及将其与神经保护药物联合使用在减少血肿方面的疗效及其对继发性脑损伤的影响。虽然rtPA在局部纤维蛋白溶解后会促进延迟性水肿形成和炎症反应，但去氨普酶（DSPA），一种源自吸血蝙蝠唾液的高度纤维蛋白选择性纤溶酶原激活剂，兼具高纤维蛋白溶解潜能且无兴奋毒性，因此是脑出血纤维蛋白溶解治疗的一种新的、有前景的候选药物。
