脑池应用重组链激酶预防猪迟发性脑血管痉挛

目的　研究重组链激酶 (r SK)在预防蛛网膜下腔出血 (SAH)后迟发性脑血管痉挛 (DCV)中的作用。方法　选取家猪 12头 ,随机分成SAH对照组和r SK治疗组 ,每组 6头 ,用腰穿枕大池置管 2次注血法制作动物模型 ;第 2次注血后 2 4h ,治疗组经留置导管注入r SK 15mg ,对照组注入生理盐水 ;两组均行脑脊液 (CSF)引流 ,并测定CSF中氧合血红蛋白 (OxyHb)含量 ;以实验前后脑血管造影和基底动脉 (BA)组织学改变作为脑血管痉挛的判定指标。结果　对照组双侧颈内动脉 (ICA)和BA明显痉挛 (P <0 .0 1) ;BA电镜和组织切片检查有内膜增生、内褶、弹力层断裂等病理改变 ;OxyHb随时间逐渐升高。治疗组总体血管直径变化无显著性差异 (P >0 .0 5 ) ;BA均正常 ;OxyHb随时间逐渐降低。结论　r SK可溶解蛛网膜下腔中的血凝块 ,预防SAH后DCV的发生

Effect of Recombinant Streptokinase on Preventing Pigs from Delayed Cerebral Vasospasm after Subarachnoid Hemorrhage

Purpose To study the effect of recombinant Streptokinase on preventing pigs from delayed cerebral vasospasm after subarachnoid hemorrhage. Methods Preventive effect of recombinant streptokinase (r SK) was applied in pigs with delayed cerebral vasospasm (DCV) after subarachnoid hemorrhage (SAH).12 pigs weighing between 10 and 12 kg were randomly divided equally into SAH control and r SK treatment groups.After initial angiogram of internal cervical artery(ICA), SAH were produced by two times injections of arterial blood into cisterna magna via a catheter inserted through lumbar puncture.For each pig of the r SK group, 15 mg r SK was administered through the catheter at 24 hours after second blood injection ,while saline administered for each one of the control group at the same time. 1 to 2 mL cerebral spinal flood (CSF) was drained from the catheter separately at 6,12 hours and 1,3,5,6 days after r SK or saline used. Oxyhemoglobin (Oxy Hb) in CSF at 1,3,5,6 days was also measured. On 6th day after r SK or saline administered, second angiograms of ICA were performed and basal arteries were taken for light micros cope and transmission electron microscope from each pig. Results On second angiography, severe vasospasm of bilateral ICA and BA were developed in all pigs of SAH control group( P <0.01), and in the r SK groups no changes occurred except for vasospasm of bilateral ICA and BA of one pig and BA of another pig ( P >0.05). Typical proliferative vasculopathy of BA were found in all pigs of SAH control group by histological examination whereas no changes occurred in the r SK groups.Oxy Hb in CSF of the control group were increased by times while decreased in the r SK group. Conclusions Intracisternal injection of r SK could resolve blood clots in the subarachnoid and prevent delayed cerebral vasospasm effectively.