急性期血肿抽吸引流术对脑起保护作用的机制研究  

A study of protective mechanism of stereotactic CT-guided aspiration and drain of acute intracerebral hemorrhage

作　　者：殷小平[1] 张苏明[1] 张新江[1] 姜亚平[1] 方思羽[1] 王苇[2] 夏黎明[2] 

机构地区：[1]华中科技大学同济医学院附属同济医院神经内科,湖北武汉430030 [2]华中科技大学同济医学院附属同济医院放射科磁共振室,湖北武汉430030

出　　处：《中风与神经疾病杂志》2002年第6期360-362,共3页Journal of Apoplexy and Nervous Diseases

摘　　要：目的 观察脑出血急性期灶周水肿的演变规律和血肿抽吸引流术前后的影像学改变,探讨该手术治疗价值的理论依据。方法 采取乳猪的自体血脑叶出血模型。以1.5T的MRI借助EPI等软件动态观察出血后O.5、3、24、48、72h脑水肿演变规律,并与对照组(注入凝血酶500U)比较。观察部分脑出血患者超早期血肿抽吸引流治疗的手术前后的CT变化及穿刺物检查。结果 脑出血后1h血肿周围出现高信号区,而此时DwI未发现异常。动态MRI序列提示出血后灶周水肿在48h达高峰。对照组O.5、3h水肿程度轻。3h脑大体标本可以看到血肿周围的半透明区。脑出血患者发病6h内CT可见明显的灶周水肿带,穿刺引流定位于血肿表层,可以抽出清亮液体5～11ml,检验提示为血清成分,复查CT示血肿周围水肿带缩小或消失。结论 脑出血超早期灶周水肿与血块收缩有关,超早期血肿抽吸引流术能减轻细胞毒性脑水肿。Objective To observe the evolvement of perihematomai edema of intracerebral hemorrhage in pigs and the change of CT-image in postsurgery and presurgery in acute intracerebral hemorrhagic patients. To try to investigate theoretic basis of therapeutic value with stereotactic CT-guided aspiration and drain. Methods We produced lobar hematomas by pressure-controlled infusions of 2. 5ml of autologous blood into the right frontal hemispheric white matter in 15 minutes, and dynamic observed the edema change at 30th minute, 3rd, 24th, 48th and 72th hour after hematoma detected with echo-planar imaging (EPI), fluid-attenuated inversion recovery (FLAIR) and T1, T2, T2 sequences. Compared with pigs infused 500U thrombin. We also observed the change of CT image of intracerebral hemorrhagic patients who treated by CT-guided aspiration and drain within 6 hours and examined the liquid aspirated in surgery. Results The MRI of pig displayed that high signal of T2 -sequence showed aroung the hematoma at the first hour, but the DWl-sequence hadn't shown abnormality at the same time, the perihematomai edema was fiercest at 48 hour, however, the edema degree of pigs treated by thrombin as unse-rious at the first hour and third hour. We could see the translucent region around the hematoma of brain preparation of pigs at 3rd hour. The brain CT of intracerebral hemorrhagic patients displayed that there was edema region around the hematoma within 6 hours, and it disapeared or decreased in postsurgery . During the surgery we could aspirate schedule liquid 5 to 11 millilitre .which was component of blood serum through checking. Conclusions Ultra-early perihematomai edema contributes to clot retraction in 1CH, and the therapy of aspiration and drain can reduce perihematomai edema caused by blood toxicity.

关 键 词：急性期 血肿抽吸引流术 脑出血 水肿 脑保护作用 CT引导 

分 类 号：R743.34[医药卫生—神经病学与精神病学]