脑出血患者血肿周围组织病理及超微结构变化的动态观察

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。

A dynamic observation of pathologic and ultrastructural changes of perihematoma in intracerebral hemorrhage patients

Background In recent years,some researches had been conducted on the pathologic changes of the secondary injury of perihematoma in animal experiments,but only a few studies had been done on the dynamic pathologic and ultrastructural changes of the perihematoma in ICH patients. The unique contribution of our study is to investigate the dynamic pathologic and ultrastructural changes of the perihematoma in ICH patients and provide significant insights into how the pathophysiology and ultrastructures changed after ICH.Methods The written informed consents were obtained from the ICH patients or their relatives. 30 patients (the supertentorial hemotoma volume＞30 mi and the cerebellar hemotoma volume ＞10 mi) were divided into 8 groups according to the time passed after ICH:＜6 h (6 patients), 6 ～ 12 h (7 patients), 12 ～24 h (5 patients), 24～48 h (3 patients), 48 ～72 h (3 patients), 3 ～4 days group (3 patients), 5 days group (2 patients) and 8 days group ( 1 patient) and subjected to craniotomy for hemotoma evacuation. During the operation for the hemotoma's evacuation, a small amount of tissues that must be removed, which located at 1 cm near the hematoma, were taken as experimental groups; And the same tissues of 7 patients (＜12 h), which were far from the hemotoma on the operational way, were taken as control group. The pathologic and ultrastructral changes were observed.Results The tissues of the control group were almost normal while the damages of the tissues from the experimental groups were slight in ＜6 h groups, more severe after 6h and got to the maximum between 24 ～48 h , recovered gradually after 72 h, became similar to the 6 ～ 12 h group on 5 th day, got better on 8 th day and resembled the 6 h group.Conclusions The injury of the perihematoma occurred in early stage, reached the peak level between 24 and 48 hours after ICH; which was consistent to the clinical nervous functional deficits in the ICH patients.