Kaufman H H, Schochet S, Koss W, Herschberger J, Bernstein D
Neurosurgery. 1987 Mar;20(3):403-7. doi: 10.1227/00006123-198703000-00008.
Simple aspiration to remove acute intracerebral hematomas has been thwarted by the solidity of the clot. Urokinase, a first generation fibrinolytic agent, has been used to liquefy such clots with some success. Therefore, tissue plasminogen activator (t-PA), a second generation fibrinolytic drug that may be safer and more effective, was studied to evaluate its ability to lyse clot in vitro and its reactivity in the brain and subarachnoid space. t-PA seems to cause partial clot lysis in small dosages (3750 units/70-cc clot) and in a short time (15 minutes). It seems to perfuse through the clot when injected in one place. It does not cause inflammation or bleeding when injected into the rat brain, but indeed seems to promote resorption of blood when the two are injected together. It does not cause aseptic meningitis when injected into the cisterna magna of rabbits. t-PA may prove to be an important adjuvant to the stereotactic aspiration of intracerebral hematomas. It may be particularly helpful in lysing these clots to make possible more gentle aspiration, removing the risk to surrounding brain of strong vacuum.
单纯抽吸以清除急性脑内血肿一直因血凝块的坚固性而受挫。第一代纤溶药物尿激酶已被用于溶解此类血凝块并取得了一定成功。因此，对组织型纤溶酶原激活剂（t-PA）进行了研究，它作为第二代纤溶药物可能更安全有效，以评估其在体外溶解血凝块的能力以及在脑和蛛网膜下腔中的反应性。t-PA在小剂量（3750单位/70立方厘米血凝块）和短时间（15分钟）内似乎能导致部分血凝块溶解。当在一处注射时，它似乎能渗透过血凝块。将其注入大鼠脑内时不会引起炎症或出血，但当二者一起注射时确实似乎能促进血液吸收。将其注入兔的枕大池时不会引起无菌性脑膜炎。t-PA可能被证明是脑内血肿立体定向抽吸的一种重要辅助手段。它在溶解这些血凝块方面可能特别有帮助，从而使更轻柔的抽吸成为可能，消除强负压对周围脑组织的风险。
