外伤后急性弥漫性脑肿胀CT值变化与超微结构损伤关系探讨  

The Investigation on Relationship Between the CT Value and Injury of Ultrastructure in Posttraumatic Acute Diffuse Brain Swelling

作　　者：张世荣[1] 任峰奇[2] 王长安[3] 韩建林[1] 常树林[1] 杨少毅[4] 

机构地区：[1]西安市中心医院神经外科,陕西西安710003 [2]西安市中心医院放射科,陕西西安710003 [3]西安市中心医院病理科,陕西西安710003 [4]西安交通大学医学院电镜教研室

出　　处：《实用放射学杂志》2004年第8期679-681,共3页Journal of Practical Radiology

摘　　要：目的　观察人脑外伤后急性弥漫性脑肿胀脑CT值和超微结构变化关系。方法　比较 9例急性弥漫性脑肿胀患者伤后和手术前脑组织CT值的变化 ,结合术中所取 3 6份损伤脑组织中毛细血管和脑实质细胞超微结构变化 ,探讨脑组织CT值下降与超微结构损伤的关系。结果　术前脑组织的CT值比伤后首次CT值低 2 .5～ 4.3HU。电镜下见 :毛细血管管腔扩张和狭窄并存 ,血管周围和细胞间出现大片水肿区。神经元细胞核仁边移或消失 ;染色质呈点状或团块状凝集 ,核膜迂曲 ;核周可见大片脂滴及空白区 ;细胞质内线粒体肿胀、嵴模糊或消失 ,粗面内质网扩张、有脱颗粒现象。神经轴索肿胀 ,轴索部分断裂。星形胶质细胞损伤与神经元细胞相似。结论　急性弥漫性脑肿胀脑组织CT值下降与脑血管源性脑水肿。Objective To study the relationship between the CT value and injury of ultrastructure in posttraumatic acute diffuse brain swelling(PADBS). Methods The change of CT value of brain tissue was analyzed at posttrauma and preoperation in 9 patients, in combination with the ultrastructure in brain parenchyma in 36 specimen taken from operations. The relationship between the descend of CT value and ultrastructure injury was analysed.Results The CT value of brain in preoperation was lower than it in posttrauma first scanning(2.5～4.3 HU).The capillary distention and stenosis and the diffuse edema in pericapillary and intercellular were observed under transmission electron microscopy(TEM). The nucleolus of neuronal cells displaced to membrane or disappeard. Chromation agglutionation, nuclear membrane circuity, perinuclear diffuse lipid drops and blankspace were detected. The mitochondrion swelling, mitochondrial crest blurring or effacement, rough endoplasmic reticulum distension and its’ granules detachmen were also seen under TEM. Axolemma edema, microfilaments and microtubules derangement in axis-cylinder were found too. The similar phenomena existed in astrocyte.Conclusion The descent of CT value in PADBS was relevant to the aggravation of vasogenic cerebral edema, cytotoxic cerebral edema and ultrastructure injury in brain parenchyma.

关 键 词：脑 外伤 体层摄影 X线计算机 超微结构 

分 类 号：R742[医药卫生—神经病学与精神病学] R814.42[医药卫生—临床医学]