脑梗塞后出血的临床病理研究

A clinicopathological study of cerebral hemorrhage following cerebral infarction

观察脑梗塞后出血脑组织的病理变化。方法在４４例脑梗塞尸检病例中，选出１７例肉眼可见的梗塞后出血，对其进行临床分析和病理观察。结果毛细血管型出血１１例，发生在皮层附近，出血灶散在呈片状，为漏出性或破裂性出血，发病晚，支持血液再灌注论点。小动脉型出血６例，发生在基底节附近，出血量大，为破裂性出血。结论梗塞后出血多发生于靠近大脑皮层的大、中等面积脑梗塞之后。发病时间的早晚、临床症状的轻重和预后与再出血的血管有关，与再出血的量呈正相关。

Objective The purpose of this study was to make an anatomicopathological observation of cerebral post infarctional hemorrhage, with reference to the related pathogenic mechanism. Method Of the 44 autopsy cases of brain infarction, 17 cases had macroscopic peri infarctional hemorrhage and were studied with microscopic examination using special staining of the relevant microsections. Results Of the 17 cases, 11 showed capillary hemorrhage which resulted from 1arge or medium sized infarctions adjacent to the cerebral cortices and appeared to be petechial, macular and scattering. The hemorrhage occurred late in a transudatory manner or tooked place as a result of rhexin. 6 cases had hemorrhage from the arter iolar rhexin near the basal ganglia. Conclusion The anatomical sites and types of the bleeding vessels had positive correlation to the abruptness of the onset and to the severity of the clinical manifestations and prognosis. The clinicopathological analysis of the 17 cases studied might support the blood reperfusion concept of the cerebral post infarctional hemorrhage.