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目的 探讨大脑中动脉 (MCA)闭塞时缺血侧不同部位的病理演变特征 ,研究缺血性损伤程度与缺血时间的关系。方法 利用线栓法 MCA闭塞模型 ,采取 HE染色 ,光镜电镜观察 MCA闭塞不同时相点缺血侧基底节区、皮质和海马的损伤特征 ,并直接对坏死和暗神经元计数 ,运用对数方程作出脑损伤程度 -缺血时间关系曲线 ,运算 ET5 0 值。结果 缺血 30分钟 ,坏死神经元首先出现在缺血侧基底节区 ,以后逐渐扩展到皮质 ,至缺血 2 4小时后 ,缺血中心逐步出现盘状坏死。缺血时间依赖性病理变化完全符合剂量反应曲线的S-形分布。结论 MCA闭塞后 ,MCA分布区的病理变化可分为组织水肿期、神经元急剧损伤期和盘状坏死期三个阶段。治疗窗因阻塞血管和缺血部位及组织可逆的期望值不同而异。主张治疗窗应“个体化”
Objective To investigate the pathological changes in different parts of ischemic side of occlusion of middle cerebral artery (MCA) and to study the relationship between ischemic injury and ischemic time. Methods MCA occlusion model was adopted. HE staining and light microscopy were used to observe the damage characteristics of ischemic basal ganglia, cortex and hippocampus at different time points after MCA occlusion, and the necrotic and dark neurons were counted directly. The equation gives the degree of brain injury-ischaemia time curve, computing ET5 0 values. Results After 30 minutes of ischemia, necrotic neurons first appeared in the ischemic basal ganglia and gradually extended to the cortex. After 24 hours of ischemia, the ischemic center gradually developed disc-like necrosis. Ischemic time-dependent pathological changes fully corresponded to the S-shaped distribution of the dose response curve. Conclusion After MCA occlusion, the pathological changes of MCA distribution can be divided into three stages: tissue edema, sharp neuron injury and discoidic necrosis. The window of treatment varies depending on the expected value of occlusion of blood vessels and the reversibility of ischemic sites and tissues. Advocate treatment window should be “individualized”