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背景五年来,人们已经在动物脑内对脑出血血肿周围的病理改变进行了一些研究,然而很少人对脑出血后血肿周围的病理和超微结构进行评估。因此,本研究的目的是观察脑出血患者血肿周围组织普通病理及超微结构的动态变化。方法对30例脑出血患者采取非功能区漏斗式入颅,在入颅路径过程必须切除的脑组织中,把远离血肿的脑组织作为对照组(发病12h以内),靠近血肿旁1cm脑组织作为实验组。按发病到手术的时间将实验组分为6h以内组6例,6~12h组7例,12~24h组5例,24~48h组3例,48~72h组3例,3~4d组3例,5d组2例,8d组1例。应用光镜和电镜观察脑组织普通病理及超微结构的动态变化。结果对照组脑组织形态和结构基本正常。实验组6h以内脑组织有轻微损伤。6h以后脑组织损伤逐渐加重。24~48h损伤达高峰,光镜显示脑细胞和纤维水肿明显,细胞形态不完整,核固缩,炎性细胞浸润明显;电镜显示神经元细胞核变空染色质聚集,线粒体肿胀,嵴变短或消失,核糖体减少,次级溶酶体增加,细胞变空,细胞膜不完整,胶质细胞核固缩。72h以后损伤逐渐好转,5d时损伤与6~12h组相似,8d时基本好转,与6h以内组基本接近。结论脑出血后血肿周围脑组织继发性损伤早期就有病理改变,损伤高峰在24~72h,与一般脑出血临床神经功能损害的变化规律基本一致,可能与血肿周围组织的继续发性损伤有关。
Background In the past five years, pathological changes around the hematoma of the intracerebral hemorrhage have been studied in the brain of animals. However, few people have evaluated the pathology and ultrastructure around the hematoma after intracerebral hemorrhage. Therefore, the purpose of this study was to observe the changes of the normal pathology and ultrastructure of the perihematoma tissue in patients with intracerebral hemorrhage. Methods A total of 30 patients with intracerebral hemorrhage were enrolled in the study. The brain tissue removed from the hematoma was taken as the control group (within 12 hours after onset) and 1 cm near the hematoma test group. According to the time from onset to operation, the experimental group was divided into 6 cases within 6h, 6 ~ 12h with 7, 12 ~ 24h with 5, 24 ~ 48h with 3 ~ 48 ~ 72h, 3 ~ 4d with 3 Cases, 5d group 2 cases, 8d group 1 case. Light microscopy and electron microscopy were used to observe the changes of brain pathology and ultrastructure. Results The morphology and structure of brain tissue in control group were normal. The experimental group 6h brain tissue within a slight injury. 6h after brain injury gradually increased. 24 ~ 48h, the damage reached the peak. The light microscope showed that the brain cells and the fibrous edema were obvious, the cell morphology was incomplete, the nuclear pyknosis and inflammatory cell infiltration were obvious. Electron microscope showed that the nucleus of the neuron became empty and the chromatin gathered, the mitochondria swelled, Disappeared, reduced ribosomes, increased secondary lysosomes, empty cells, imperfect cell membranes, and pyknotic glandular nuclei. After 72h injury gradually improved, 5d injury and 6 ~ 12h similar group, 8d basically improved, and basically within 6h group. Conclusions Cerebral hemorrhage may cause pathological changes in the early stage of secondary injury of hematoma surrounding the hematoma. The peak of injury is between 24 and 72 hours, which is consistent with the changes of clinical neurological impairment in general intracerebral hemorrhage and may be related to the persistent injury of the perihematoma .