脑出血血肿形成过程中的管涌现象

Piping phenomenon in process of hematoma formation of intracerebral hemorrhage

目的对脑出血"环状出血"现象进行实验研究,初步探讨其病理机制。方法SD大鼠随机分为实验组、模型组及假手术组,采用"两次注射自体动脉血法构建的大鼠尾状核脑出血模型",分别用自体动脉血及墨汁标记的自体动脉血制作脑出血模型,脑组织常规HE染色,观察组织形态变化。结果实验组及模型组大鼠尾状核均可见血肿形成。部分血液反流至同侧胼胝体及脑室。大部分血肿沿内囊向后扩展。小血管周围可见"环状出血"灶,血液均有墨汁标记。结论"环状出血"是原发血肿沿血管周围间隙向周围扩展;也可以沿神经纤维周围间隙向外围扩展。血肿沿组织间隙向远端扩展的这种特性我们称之为"管涌现象"。"管涌现象"与脑出血的发生、发展及预后有密切关系。

Objective To explore the pathological mechanism of ring hemorrhage, the spot hemorrhage around vessel. Methods Twelve adult male Sprague-Dawley rats were divided into three groups, five in each experimental group （ink perfusion group and ink-marked hematoma group） and two in the control group. The ICH rat model was made by injection of autologous blood and ink-marked autologous blood. Rats of ink-marked hematoma group were operated to produce hematoma with autologous blood marked by Indian ink. Brain sections were stained with hematoxylin and eosin （HE）. Results In the ink perfusion group, hematoma extended along vessels without rupture. In the ink-marked hematoma group, ring hemorrhage was found in perihematomal tissue and was located in not only perivascular space but also periphery of neurofibrae. All ring hemorrhage was marked by ink, which meant that the blood of ring hemorrhage came from the hematoma. Conclusions Ring hemorrhage,which exists extensively in the perihematomal tissue, is formed by overflow of the blood of hematoma into the perivascular space and periphery of neurofibrae. We call it ＂piping phenomenon＂, essentially similar to the piping crisis formed by leakage of fluid via the porous dyke. Piping phenomenon is probably one of the main pathological mechanisms of manifestations of ICH, such as secondary cerebroventricular haemorrhage, secondary subarachnoid hemorrhage and multifocal ICH.