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目的:探讨实验性脑出血微创抽吸术联合腹腔、血肿腔应用单唾液酸四己糖神经节苷脂(GM1)对脑出血急性期神经功能的影响。方法:将Ⅳ型胶原酶注入SD大鼠尾状核诱导形成脑出血10h后,向血肿腔内注入尿激酶溶解血凝块,实施微创血肿抽吸术排出脑内血肿,通过对抽吸组、抽吸腹腔给药组、抽吸血肿腔给药组之间不同时间脑组织caspase-3,GFAP免疫组化检测,大鼠神经功能缺损评分,对微创抽吸术联合2种途径应用GM1的神经功能影响进行评估。结果:血肿腔、腹腔给药组同抽吸组比较,3d(P<0.05)、5d、7d的caspase-3,GFAP阳性细胞数及蛋白表达量明显减少,尤其是5d、7d的减少更显著(P<0.01)。血肿腔给药组和腹腔给药组比较,前者3d(P<0.05)、5d、7d的caspase-3,GFAP阳性细胞数及蛋白表达量明显减少,尤其是5d、7d的减少更明显(P<0.01)。血肿腔、腹腔给药组同抽吸组比较,3d(P<0.05)、5d、7d的神经功能恢复较显著,尤其是5d和7d神经功能恢复更显著(P<0.01);血肿腔给药组和腹腔给药组比较,前者的3d(P<0.05)、5d、7d神经功能恢复显著,5d、7d差异更显著(P<0.01)。结论:脑出血神经功能缺损可能与细胞凋亡和反应性星形胶质细胞增生有关。单唾液酸四己糖神经节苷脂有抑制脑出血细胞凋亡和反应性星形胶质细胞增生作用。脑出血立体定向血肿抽吸联用单唾液酸四己糖神经节苷脂局部血肿腔给药是实验性脑出血脑保护作用更经济、有效的治疗方案。
Objective: To investigate the effects of monosialotetrahexosyl gangliosides (GM1) on the neurological function in patients with acute cerebral hemorrhage after experimental cerebral hemorrhage minimally invasive aspiration combined with intraperitoneal and hematoma cavity. Methods: The type Ⅳ collagenase was injected into the caudate nucleus of SD rats to induce cerebral hemorrhage for 10 hours. The urokinase was dissolved into the hematoma to dissolve the blood clot. The hematoma was removed by minimally invasive hematoma aspiration. , Aspiration intraperitoneal injection group, aspiration group and hematoma cavity administration group at different time, immunohistochemistry of caspase-3, GFAP, neurological deficit score, minimally invasive aspiration combined with two ways GM1 The neurological effects were evaluated. Results: The number of caspase-3 and GFAP positive cells and protein expression in the hematoma cavity and intraperitoneal administration group were significantly decreased on the 3d (P <0.05), and on the 5th and 7th day, especially on the 5th and 7th day (P <0.01). Compared with the intraperitoneal injection group, the number of caspase-3 and GFAP positive cells and the expression of GFAP in the former group were significantly decreased on the 3d (P <0.05) and the latter on the 5th and 7th day (P <0.01). In the hematoma cavity and intraperitoneal group, the recovery of neurological function was significant at 3d (P <0.05), 5d and 7d, especially at 5d and 7d (P <0.01). Hematoma cavity administration Compared with the intraperitoneal injection group, the neurological function recovered significantly on the 3d (P <0.05), and on the 5th and 7th day (P <0.01). Conclusion: Neurological deficits of cerebral hemorrhage may be related to apoptosis and reactive astrocyte proliferation. Monosialotetrahexosyl gangliosides inhibit cerebral hemorrhagic apoptosis and reactive astrocyte proliferation. Intracranial hematoma stereotactic hematoma aspiration combined with monosialin tetrahexose ganglioside local hematoma cavity administration is more economical and effective treatment of experimental cerebral hemorrhage brain protection.