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目的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入颅直视手术,清除血肿前于血肿旁约1cm处取少许脑组织作为实验组,按发病到手术的时间分为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。从12h以内组中的7例患者于手术入颅路径上远离血肿处取少许脑组织作为对照组。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,炎性细胞侵润明显;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。
Objective To observe the changes of the common pathological and ultrastructural changes in the perihematomal brain tissue of patients with intracerebral hemorrhage. Methods Thirty patients with intracerebral hemorrhage underwent non-functional craniofacial surgery. Before removal of the hematoma, a small amount of brain tissue was taken at about 1 cm beside the hematoma as the experimental group. According to the time from onset to surgery, 6 patients were divided into 6 groups, 7 cases in 12h group, 5 cases in 12 ~ 24h group, 3 cases in 24 ~ 48 hours group, 3 cases in 48 ~ 72 hours group, 3 cases in 3 ~ 4 days group, 2 cases in 5 days group and 1 case in 8 days group. From 12h within the group of 7 patients in the operation into the cranial path away from the hematoma and take a little brain tissue as a control group. Light microscopy and electron microscopy were used to observe the changes of brain pathology and ultrastructure. Results The morphology and structure of brain tissue in control group were normal. The experimental group 6h brain tissue within a slight injury. 6h after brain injury gradually increased. 24-48 hours after injury reached the peak, light microscope showed that the brain cells and fibrous edema were obvious, cell morphology is incomplete, nuclear pyknosis, infiltration of inflammatory cells significantly; electron microscopy showed neuronal nuclei become empty of chromatin aggregation, mitochondria swelling, crest shortening Or disappear, ribosome reduction, increased secondary lysosomes, empty cells, incomplete cell membranes, glial cell nuclear condensation. After 72h injury gradually improved, 5d injury and 6 ~ 12h similar group, 8d basically improved, and basically within 6h group. Conclusion Cerebral hemorrhage in the hematoma around the brain tissue secondary pathological changes early injury, the peak of injury in 24 ~ 72h, and general cerebral hemorrhage clinical neurological damage consistent with changes in the law.