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目的探讨血肿周围组织病理发展进程及其与血肿周围局部脑血流变化的关系。方法采用自体血注射法制备大鼠脑出血模型,对70只大鼠于术后1h、3h、6h、12h、24h、48h和72h7个时间点,利用GELightspeed螺旋CT扫描机灌注成像及计算机辅助系统制作大鼠脑CT灌注参数图,对血肿周围局部脑血流量(rCBF)、局部脑血容量(rCBV)和对比剂平均通过时间(MTT)脑血液动力学参数进行定量测量,并与大鼠脑TTC染色、HE-染色以及超微结构改变进行比较。结果大鼠脑血肿周围可见明显的低灌注梯度,血肿周围rCBF和rCBV显著降低,MTT延长。TTC染色血肿周围未见白色梗死区。HE-染色可见血肿周围区星形细胞肿胀,神经细胞变性、坏死,出血灶周边毛细血管增生伴炎细胞浸润。电镜观察显示,注血早期血肿周围组织星形细胞肿胀,神经细胞改变不明显,髓鞘板层松散;随着注血后时间延长,血肿周围组织损伤呈渐进性加重,星形细胞肿胀明显,神经细胞出现变性,髓鞘板层发生局部断裂、崩解。结论大鼠脑注血早期血肿周围局部脑血流的显著降低引发了血肿周围及远隔区脑组织的缺血性损伤,注血后急性期血肿周围组织细胞损伤呈进行性加重,血肿周围存在涉及多种细胞损伤机制的半暗带。
Objective To investigate the histopathological progression around hematoma and its relationship with the changes of regional cerebral blood flow around hematoma. Methods A rat model of intracerebral hemorrhage was established by autologous blood injection. Seven rats were anesthetized with GELightspeed CT scanner at 1 hour, 3 hours, 6 hours, 12 hours, 24 hours, 48 hours and 72 hours after operation. The CT perfusion parameters of rat brain were established to quantitatively measure the cerebral hemodynamic parameters of local cerebral blood flow (rCBF), local cerebral blood volume (rCBV) and contrast passage-time (MTT) TTC staining, HE-staining and ultrastructural changes were compared. Results There was obvious low perfusion gradient around the cerebral hematoma in rats. The rCBF and rCBV around the hematoma were significantly decreased and the MTT prolonged. TTC stained hematoma around no white infarction area. Hematoxylin and eosin staining showed that astrocytes around the hematoma were swollen, degeneration and necrosis of nerve cells, capillary proliferation around the hemorrhage and inflammatory cell infiltration. Electron microscopy showed that astrocytes swollen around the hematoma in the early stage of injection, and the changes of the nerve cells were not obvious. The myelin sheath was loose. With the prolonged time after injection, the tissue damage around the hematoma gradually increased and the astrocytes swell obviously, Degeneration of nerve cells, local myelin sheath rupture, disintegration. Conclusion The significant reduction of local cerebral blood flow around the hematoma in the early stage of cerebral perfusion in rats leads to the ischemic injury of the brain tissue around and behind the hematoma. The injury of perihematomal cells around the hematoma in the acute phase is progressively aggravated and exists around the hematoma Penumbra involving multiple cell damage mechanisms.