脑出血后不同时间血肿周围病理及超微结构变化的研究

Secondary injury to perihematoma in intracerebral haemorrhage

目的研究高血压脑出血后不同时间血肿周围病理及超微结构变化。方法按时间因素将手术的100例脑出血分为〈6h（A组）、6～23h（B组）、24～71h（C组）、1〉72h（D组）4组；按血肿量分为30—49ml（Ⅰ组）、50～69ml（Ⅱ组）、70～89ml（Ⅲ组）、≥90ml（Ⅳ组）4组，分别在光学和透射电镜下观察不同时间段血肿周边靠近皮层区的脑组织超微结构变化。结果光镜下可见血肿区与正常脑组织间细胞不同程度水肿，星形细胞肿胀；电镜下可见血肿周围组织在出血早期星形细胞胞体和周边足突肿胀；24h星形细胞肿胀明显，部分变性、坏死，神经细胞轻度变性，血脑屏障破坏；72h星形细胞高度肿胀，神经细胞变性。相关分析显示，病理和超微结构变化与时间呈显著正相关（χ21=38．343、χ22=48．645，P〈0．001），而与血肿量无关（P〉0．05）。结论不同时间段血肿周围脑组织的损害程度不同，与出血时间呈线性趋势。

Objective To study the pathologic and ultrastrueture change of perihematoma in different time after intracerebral haemorrhage （ICH）. Methods According to the time after intraeerebral haemorrhage, total 100 operated instances were divided into 4groups： 〈6 h, 6 -23 h, 24 -71 h, ≥72 h. According to the quantity of hematoma, the instances were divided into 4groups ： 30 - 49 ml, 50 - 69 ml, 70 - 89 ml, ≥ 90 ml. We observed the brain tissue around hematoma where was near the cortical field at transmission electron microscope and light microscope. Result there was a transitional zone between hematoma and normal tissue under microscopy, and the involved tissue was looked loose with varied edematous cells and swollen astroeytes. Meanwhile, capillary hyperplasia around hematoma with foot plate swollen were detected. 24h after blood injection, astroeytes started to swell, part of them became degenerated and necrosis. Neural cells appeared mild degenerated and blood brain barrier were destroyed. 72h after ICH, astroeytes showed highly swollen with neural cells degenerated. The correlation analysis showed that there was a remarkable positive correlation between the pathologic and ultrastrueture change and time （χ21 = 38. 343, χ22 =48.645, P 〈0.001） ,but was not with the quantity of hematoma（ P 〉0.05）. Conclusion The degree of damage of brain tissue was varietied in different time. The relation between the brain tissue around haematoma and time were linear tendency.