通窍活血汤预防迟发性脑血管痉挛的实验研究

目的实验研究通窍活血汤对蛛网膜下腔出血(SAH)后迟发性脑血管痉挛(DCV)的预防作用,分析其作用机理。方法弥猴随机分为两组(各4只),开颅右侧大脑中动脉(MCA)近端旁置微透析管后自体动脉血覆盖复制SAH模型。SAH后治疗组予通窍活血汤、对照组予安慰剂连续口服12d。SAH前4d、SAH后7d,两次右颈内动脉造影。连续12d收集每天微透析液,分光光度法测量其氧合血红蛋白(OxyHb)浓度。结果两次造影治疗组右MCA近端口径无明显变化(P>0.05),而对照组缩小明显(P<0.05),有严重的血管痉挛。OxyHb浓度:两组SAH后2￣5d无明显差异(P>0.05),6￣8d治疗组(8d后为零)明显低于对照组(11d后为零;P<0.05),治疗组峰值(5d)明显低于对照组峰值(7d;P<0.05)。结论通窍活血汤能有效预防SAH后DCV,降低SAH后血管周边OxyHb浓度可能是其作用机理。

The experimental study on the prevention effects of Tongqiaohuoxue Decoction on delayed cerebral vasospasm after subarachnoid hemorrhage

Objective To study the prevention effects and the physicochemical mechanisms of action of Tongqiaohuoxue Decoction on delayed cerebral vasospasm(DCV) after subarachnoid hemorrhage (SAH).Methods Macaca cynomolgus were divided into two groups(both four animals) and underwent craniectomy,a semipermeable microdialysis catheter was placed adjacent to right middle artery (MCA); 5ml arterial blood was then placed around the MCA and the catheter. Treatment group was exposured to Tongqiaohuoxue Decoction and control group to placebo both for 12 days after operation. Right internal carotid artery angiographys were performed on 4 days before SAH and 7 days after SAH. The dialysate was collected daily for 12 days. Levels of oxyhemoglobin were measured by means of spectrophotometry.Results The diameter of proximal MCA in treatment group changed slightly on 7th day, whereas, in control group it significantly decreased indicating severe vasospasm. The concentration of oxyhemoglobin had no significant difference between two groups on 2nd to 5th day after SAH (P>0.05), but significantly decreased in treatment group on 6th to 8th day (P<0.05) compared with control group and could not be detected on 9th to 12th day (control group on 12th day). The peak concentration of oxyhemoglobin in treatment group(on 5th day) was significantly lower than in control group (on 7th day) (P<0.05).Conclusion It seems that Tongqiaohuoxue Decoction can effectively prevent DCV after SAH by having perivasular concentration of oxyhemoglobins decreased.