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替罗非班联合尿激酶动脉溶栓治疗急性大脑中动脉栓塞的实验研究

冯雷,潘力,冯光,贺道华,马廉亭   

  1. 广州军区武汉总医院神经外科
  • 收稿日期:2011-03-03 修回日期:2011-06-09 出版日期:2011-12-15 发布日期:2011-12-15
  • 通讯作者: 冯雷

Experimental Study on Tirofiban Combined Urokinase Intra-arterial Thrombolysis in the Middle Cerebral Artery Occlusion

  • Received:2011-03-03 Revised:2011-06-09 Published:2011-12-15 Online:2011-12-15

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摘要： 目的 探讨替罗非班联合尿激酶超选择性溶栓治疗急性大脑中动脉栓塞的疗效和安全性。 方法 采用兔自体血栓栓塞大脑中动脉制成急性脑梗塞模型，随机分为替罗非班组(T组)、尿激酶组（UK组）、替罗非班+尿激酶组（T+UK组）、对照组，分别超选择动脉内给予替罗非班、尿激酶、替罗非班+尿激酶、生理盐水。采用DSA观察动脉内超选择溶栓的血管再通率、核磁共振弥散成像观察相对表观系数（rADC）、改良Bederson评分法观察神经功能缺损。24小时后处死动物经氯化-2,3,5-三苯基四氯唑染色，作光镜病理形态学检查。 结果 替罗非班+尿激酶组再通率为80%，病理检查未见明显出血。rADC值，神经功能缺损评分，脑梗塞面积均优于替罗非班组、尿激酶组和对照组。 结论 早期使用替罗非班联合尿激酶进行动脉内溶栓在兔超早期脑缺血模型中疗效肯定、安全,能完全或部分恢复脑动脉再通，减少脑梗塞面积, 优于单纯尿激酶动脉内溶栓。

关键词: 脑栓塞, 动脉溶栓治疗, 数字减影血管造影, 磁共振成像, 弥散加权成像, 兔, 动物模型

Abstract: Abstract :Objective To establish an embolic stroke model in rabbit and explore the efficacy and safety of intra-arterial combined Tirofian and Urokinase thrombolysis on the experimental embolic stroke by comparing diffusion perfusion magnetic resonance imaging before ,during and at the end of the thrombolytic treatment and to assess the subsequent prognostic value of diffusion weighted imaging ( DWI ) and perfusion weighted imaging ( PWI ). Methods The middle cerebral artery occlusion model ( MCAO ) was established in New Zealand rabbit by autologous clot .The MCAO rabbits were randomly divided into intra-arterial tirofiban thrombolysis group ( T group ), urokinase thrombolysis group ( UK group ), combined tirofiban and urokinase thrombolysis group ( T + UK group ) and control group ( C group ). The rabbits of T group were given tirofiban , the rabbits of UK group were given urokinase, the rabbits of T + UK group were given combined tirofiban and urokinase and group C was intra-arterial saline. The recanalized rate , relative-apparent diffusion coefficient ( rADC ) and the neurologic function deficit score were compared among them .Results The repatency rate , rADC and the neurologic function deficit score of T + UK group are better than other groups. Conclution Intra-arterial combined tirofiban and urokinase thrombolysis in the rabbit middle cerebral artery occlusion model （MCAO ） is better than intra-arterial single urokinase, which can promote reperfusion and decrease infarct volume .

Key words: cerebral infarction, intra-arterial thrombolysis, digital subtraction angiography, magnetic resonance imaging, diffusion weighted imaging, rabbit, animal model