血肿内注射肝素对猪脑叶出血后血肿周围水肿的影响  

Effects of injecting heparin into the center of hematoma on perihematoma edema and hematoma volume in pigs with intracerebral hemorrhage

作　　者：张新江[1] 王苇[1] 殷小平[1] 常丽英[2] 徐广润[3] 张苏明[2] 姜亚平[2] 方思羽[2] 

机构地区：[1]江苏省扬州市第一人民医院神经内科,225001 [2]华中科技大学同济医学院附属同济医院神经内科,武汉430030 [3]山东大学齐鲁医院神经内科

出　　处：《中国危重病急救医学》2005年第5期276-278,i001,共4页Chinese Critical Care Medicine

基　　金：卫生部临床学科重点基金资助项目(97070241)

摘　　要：目的观察猪脑叶出血后血肿内注射肝素对血肿体积和周围水肿的影响。方法将13只乳猪随机分为单纯出血组和肝素组,前组在右侧额叶内注射2,5ml动脉全血;后组注射2.3ml动脉全血后血肿腔内再次注射0.2ml(500U)肝素钠。通过1.5TMRI设备,动态观察发病后30-60min和24hT2*加权成像(T2*WI)、液体衰减返转恢复快速自旋回波序列(FLAIR)成像、弥散加权成像(DWI)显示病灶(包括水肿和血肿)体积的变化,比较血肿周围组织和对侧半球组织表观弥散系数(ADC)值的差别,并观察其组织病理学变化。结果T2*WI显示,单纯出血组24h血肿体积较发病1h内无明显变化[(2.21±0.28)cm3比(2.33±0.30)cm3,P>0.05],而肝素组T2*WI显示24h时的病灶明显大于1h内[(5.29±0.98)cm3比(3.09±0.38)cm3,P<0.01]。24h时血肿增大的动物血肿周围水肿区以ADC值升高为主,但局部降低;血肿体积无变化者仅见灶周ADC值升高,无降低现象。组织病理学显示肝素组24h时血肿体积为(5.45±0.96)cm3,明显大于单纯出血者的(2.31±0.22)cm3(P<0.05)。同时发病后24hFLAIR成像和DWI均显示肝素组病灶体积较单纯出血组明显增加(P<0.05或P<0.01)。结论脑出血后血肿内注射肝素钠不仅不能减轻血肿周围组织的水肿程度,而且可导致进行性继续出血,24h时血肿增大,大量出血时血肿周围?Objective To investigate the safety and effect of injecting heparin into hematoma on perihematoma edema and hematoma volume in pigs with intracerebral hemorrhage(ICH). Methods Thirteen sucking pigs were divided randomly into two groups: hemorrhage group, in which 2. 5 ml arterial blood was injected into the right frontal lobe and heparin group. in which 0. 2 ml of heparin was injected into the hematoma produced by the injection of 2.3 ml of blood into the similar site. The hematoma volume and perihematoma edema were determined by the sequences of T2* weighted image (T2*WI), fluid-attenuated inversion-recovery(FLAIR) image and diffusion weighted image(DWI) by 1. 5 T magnetic resonance image (MRI) from 30 - 60 minutes afterwards to 24 hours. The perihematoma apparent diffusion coefficient (ADC) was compared with that of contralateral hemisphere, and the corresponding histologic changes were studied. Results The average volume, shown by T2* WI at 24 hours, was significantly larger than that at 30 - 60 minutes after hematoma formation in hemorrhagic group [(5. 29±0. 98)cm3 vs. (3. 09±0. 38)cm3, P<0. 01]. But there was no significant change in hematoma volume in hemorrhagic group from 30-60 minutes on to 24 hours [(2. 21±0. 28)cm3 vs. (2. 33±0. 30)cm3, P>0.05]. Both increased and decreased ADC were found around the hematoma in some animals of the heparin group compared with that of the contralateral hemisphere. On the other hand, in hemorrhagic group, only increased ADC could be found around the lesion, and there was no decreased ADC. Conclusion Injection of heparin into an intracerebral hematoma leads to enlargement of the hematoma and more marked perilesion edema. On ADC maps, enlargement of hematoma is attributed to the edema around the lesion leading to injury to the brain tissue.

关 键 词：血肿内注射 脑叶出血 血肿周围水肿 T2^＊加权成像 快速自旋回波序列 液体衰减返转恢复 血肿周围组织 FLAIR成像 血肿体积 弥散加权成像 表观弥散系数 动脉全血 ADC值 血肿增大 24h MRI设备 病理学变化 组织病理学 缺血性损害 

分 类 号：R743.34[医药卫生—神经病学与精神病学]