Experimental Study On Preventive And Therapeutic Effect Of Delayed Cerebral Vasospasm After Subarchnoid Hemorrhage By Intracisternal Irrigation Using Recombinant Tissue-type Plasminogen Activator

Objective: To establish a rabbit model of delayed cerebral vasospasm(DCVS) after subarachnoid hemorrhage(SAH) by"Two-hemorrhage"method .To study on preventive and therapeutic effect of DCVS by intracisternal irrigation using r-TPA, and to disscuss the clinical mechanism of r-TPA in delayed cerebral vasopasm.Method: 43 New Zealand white rabbits were randomly divided into normal control group (n=3),SAH group(n=10)and experimental groups[including nimoldipine group (n=10), r-TPA group (n=10), r-TPA combined with nimoldipine group (n=10)].Before the experiment,the angiogram of basilar artery(BA)and PET-CT were performed,then,cerebral vasopasm model in SAH group and experimental groups was made by"Two-hemorrhage"method. After cerebral vasopasm model was made,we took three methods to prevent and treat DCVS in experimental groups as follows: venous transfusion using nimoldipine, intracisternal irrigation using r-TPA and intracisternal irrigation using r-TPA combined with venous transfusion using nimoldipine. The curative effect was assessed by PET-CT , cerebral angiography and pathological section.Results : Through comparing the diameter of the basilar artery and the SUVmean,We found that there was significant difference between r-TPA group or r-TPA combined with nimoldipine group and SAH group or nimoldipine group(P<0.01);There was no difference between r-TPA group and r-TPA combined with nimoldipine group (P>0.05); There was also no difference between nimoldipine group and SAH group(P>0.05). The endorsembrance of BA was little shrinkage in the r-TPA group and r-TPA combined with nimoldipine group; The endorsembrance of BA was shrinkage in the nimoldipine group. Through evaluting the scoring system of nerves-functional in the seventh day after second blood injection,we could see there was difference between r-TPA group or r-TPA combined with nimoldipine group and SAH group or nimoldipine group(P<0.05); There was no difference between r-TPA group and r-TPA combined with nimoldipine group (P>0.05); There was also no difference between nimoldipine group and SAH group(P>0.05).Conclusion:Intracisternal irrigation using r-TPA or combined with venous transfusion using nimoldipine can treat DCVS and improve the scoring system of nerves-functional,but curative effect of the two methods have no difference.