自发性脑出血发病的血流动力学原理

（1）目的 探讨自发性脑出血的发病具有部位特异性的原因。（2）方法 应用流体力学的基本原理。并结合脑血管的局部解剖形态进行系统分析和展示。（3）结果 脑的血流量大，速度快，伴随分支血流速度减慢而来的动压力顺差变化较身体其他部位大。血管分叉部是血流速度改变的转折点。近于直角的分支以及两端均与主循环相通的分支，血流速度逆差、动压力顺差变化大，血管易于向外扩张，扩张了的血管血流速度更慢，动压力顺差更大，管壁更易向腔外进一步扩张，形成恶性循环，机体的代偿功能如果不能克服这个恶性循环，其最终结局便是血管破裂出血。（4）结论 局部血流动压力顺差变化是自发性脑邮血的重要发病原因。

HEMODYNAMIC PRINCIPLES FOR PATHOGENESIS OF SPONTANEOUS CEREBRAL HEMORRHAGE

Objective\ To investigate the high regional specificity for the pathogenesis of hypertensive cerebral hemorrhage and brain aneurysm, the major diseases of spontaneous cerebral hemorrhage.\ Methods\ Systemic analysis and illustration were based on the fundamental principles of hydrodynamics, regional anatomy of cerebral vessels, and a vast amount of clinical data of spontaneous cerebral hemorrhage cases.\ Results\ The high regional specificity of the pathogenesis of hypertensive intracerebral hemorrhage and brain aneurysm was closely related to the local cis difference change of dynamic pressure resulted from the morphological characteristics of the local blood vessels. The intravascular hemodynamic principle described here was also applicable to the explanation of other kinds of spontaneous cerebral hemorrhage. \ Conclusion\ Compared with blood flow in other tissues, blood flow in brain has relatively high volume, fast speed, and great cis difference change of dynamic pressure in vessel branches. The branching sites are the locations where flow speed changes. Branching with almost right angle bifurcation and/or with both of ends connected to the main circulation introduces higher trans difference change in flow speed and cis difference change in dynamic pressure, which leads to the dilation of local vessel walls. This dilation becomes worse when a vicious circle is formed, since the flow speed in the dilated vessels is slower and the dynamic pressure changes are higher. When this vicious circle cannot be overcome by the compensation system of the organisms, blood vessel rupture will be unavoidable.