| Since Ecker and Riemenschneider reported one case of suspected rupture of an intracranial aneurysm in 1951 and an segments narrow was shown in angiography angiographic image, people have known that after the artery tumour broke, many factors could lead to the brain blood vessel convulsion, which has caused the ischemia and the infarct in turn. Cerebral vasospasm is the severe complication for those patients who are in intracranial aneurysm break and subarachnoid hemorrhage disease. At the same time, it is still the main cause for the death of the patients with the Intracranial aneurysm break and bleeds. Therefore, it is of great value to prevent and treat cerebral vasospasm for those patients with intracranial aneurysm break. People have done a lot in removing the cerebral vasospasm. But it's a pity that an effective method has not been found to control the cerebral vasospasm. Using 3H (hypertensive hypervolemic hemodilution) treatment in the clinical work at present and the early operation which can get rid of the blood clot in subarachnoid space and intrarterial intervention can prevent and treat cerebral vasospasm to a certain extent. Intracranial delivery is an effective treatment method for preventing and treating cerebral Vasospasm. In July 2001, 29 cases reported by Dalbasti that the controlled-release papaverine pellets were used (PapaCR), which had got good result in preventing and treating cerebral vasospasm. Kasuya summarized curative effect from 20 subarachnoid space bleed cases in which the skill of implanting the claviform globulus of nicardipine prolonged-release (NPRI) was adopted in April 2002,which indicated that cerebral vasospasm incidence was far more lower than the un-therapic subarachnoid space blood patient. In China, Jun Wang,Xuejian Cai and some others has used the skill of perfusing medicine in subarachnoid space and has made certian curative effect. But limited by our conditions, there are no development and application of prolonged-release medicine yet. On the basis of the research on the prevention and treatment of cerebral vasospasm both at home and abroad, we put forward the improvement method of prevention and treatment of CVS by implanting the mix pharmaceutics of fibrin glue and papaverine. The purpose of the research is to evaluate the effect of mix pharmaceutics of fibrin glue andpapaverine in prevention and treatment cerebral vasospasm through the big mouse's experiment. In the experiment, we divided 30 Wistar big mouses whose weight are 350~450 g into 5 groups at random, 6 every groups, namely contrast the group normally, SAH 5d group, SAH 7d group, the medicine treats group 5d and medication 7d group. Group SAH adopts 1d, 3d rats in the pulvinar postcisterna pour twice into blood of autologous to make the model of subarachnoid space bleed chronic cerebral Vasospasm. Medication group adopts the same method to make SAH model. 4d implants the mix pharmaceutics of fibrin glue and papaverine in the pulvinar postcisterna. We observe animal eating situations, activity situations, put the animal to death at 5d, 7d, observe the pathological alterations and measure the diameter of blood vessel. The purpose of adopting T method in groups is to evaluate whether it will take into effect in preventing CVS by implanting the mix pharmaceutics of fibrin glue and papaverine. Animals in SAH and medication groups appear the posture whose heads low-order and crouch like a bow after injection. They are inactive, and their englobement amount of food and water has drawn, but they recover after 1d. Hemiplegia or monoplegia does not happen. The inspection result ofpathology shows that the average quality of brain is 2.5g and Willis ring, initial department in the middle cerebral artery, basilar artery were parceled by blood clot, medication groups can be seen the fibrin glue in pulvinar postcisterna. Through the microscope we can see that the smooth muscle of blood vessel shrinked, close arranged, blood vessel wall bodiness, intraluminal shrinked, internal elastic and endothelial wrinkled after seeing SAH. The medication group has not undergone unusually obvious change. Compared with the normal group, 5d group SAH, 7d group SAH, the medicine treats group 5d, the medicine treats the order of group 7d, we can see that BA diameter 237 ±18 μm, 186 ±13μm, 220 ±17μm, 236 ±20μm, 232 ±19μm; MCA diameter 155 ±10μm, 111 ±8 μm, 85 ±7.5μm, 159 ±12.5μm, 139.5±17μm. BA diameter have remarkable difference between SAH 5d group and normally group, P=0.0030, MCA diameter have remarkable difference in SAH 5d group, 7d group and normally group, P =9.2E-5,P =1.9E-6. It is no statistics value to compare the diameter of two groups BA, MCA of medication and that of the normally contrast group. There exists significant difference (P=0.0080) between the BA diameter of 5d group and that of SAH group, and has a remarkable difference between the MCA diameter of 5d group (P=0.00019) and 7d group (P =0.0011) and that of SAH group. Statistics indicates the diameter of SAH group 5d BAcontrasting with that of contrast group reduces obviously, which proves that chronic cerebral vasospasm has taken place in group 5d. There is no statistics difference between the group of SAH 7d and the normal group. It may be that mouse's blood vessel regulation mechanism is more perfect than the mankind. Compared with the Group of SAH 5d, 7d and the normal group, MCA reduced obviously, which proves that CVS has taken place in the group of 5d, 7d, and it is more obvious in 7d than the group of 5d. Meanwhile, there is no significant difference in BA diameter between the group of medication 5d, 7d and the normal group, which indicates that the mix pharmaceutics of fibrin glue and papaverine has controlled the emergence of CVS effectively. Medication 5d group, MCA diameter is longer than the diameter of normal group, medication 7d group has no difference in contrast with normal group. The results mentioned above indicate that it is effectual to use the mix pharmaceutics of fibrin glue and papaverine to cure the CVS, and the effect of medicine can sustain for more than 3 days. From the statistics result of BA and MCA, the treatment method is more efficient in expanding the micro-anapetia than the macro-anapetia. The result of study within 3 days indicates the mix pharmaceutics of fibrin glue and papaverine to cure the CVS has obvious results in treating CVS, whose result decreases progressively with time. We estimate that it may relate to the speed released by...
|
PDF Full Text Request