外伤后急性弥漫性脑肿胀合并二次脑损伤的超微结构观察  

Ultrastructural observation on acute posttraumatic diffuse brain swelling associated with secondary brain insult

作　　者：张世荣[1] 姬西团[2] 张胡金[1] 韩建林[1] 常树林[1] 李迎山[1] 樊小军[3] 杨少毅[3] 

机构地区：[1]西安市中心医院神经外科,710003 [2]第四军医大学附属西京医院全军神经外科研究所 [3]西安交通大学医学院电镜教研室

出　　处：《中华创伤杂志》2004年第5期264-266,共3页Chinese Journal of Trauma

摘　　要：目的　探讨外伤后急性弥漫性脑肿胀合并二次脑损伤患者的脑组织超微结构变化与预后的关系。　方法　对 8例外伤后急性弥漫性脑肿胀合并不同程度二次脑损伤患者行内减压手术 ,留取 32份脑组织标本 ,透射电镜下观察神经元、星形胶质细胞和毛细血管的超微结构变化 ,分析其与预后的关系。　结果　按格拉斯哥预后评分 (GOS) :良好 1例 ,中残 2例 ,重残 1例 ,植物生存 1例 ,死亡 3例。良好和中残的患者 ,神经元和星形胶质细胞超微结构基本正常 ,血管源性脑水肿为主 ,细胞内水肿较轻 ,毛细血管扩张充血。其余患者中 ,神经元和星形胶质细胞核膜迂曲 ,核仁偏移 ,染色质凝集 ,线粒体和粗面内质网的超微结构明显损伤 ,细胞内水肿和血管源性脑水肿均较重 ,毛细血管狭窄缺血。　结论　外伤后急性弥漫性脑肿胀合并二次脑损伤患者的脑组织超微结构损伤越重 ,预后就越差。Objective To explore the relationship between ultrastructural changes of brain tissues and prognosis following posttraumatic acute diffuse brain swelling (PADBS) complicated by secondary brain insult (SBI). Methods From eight PADBS patients with SBI treated with intra-decompression,32 specimens were collected to observe the ultrastructural changes of neurons,glial cells and capillaries by transmission electron microscopy (TEM) and analyze the relationship of the ultrostructural changes with the prognosis. Results Based on the Glasgow outcome scale (GOS),one patient was with sound recovery,two with moderate disability,one with severe disability,one under persistent vegetative state and three died. Of the patients with good recovery and moderate disability,the ultrastructures of neurons and glial cells were almost normal with mainly vasogenic cerebral edema,insignificant intracellular cerebral edema and capillary congestion. As for the neurons and the glial cells in the other patients,nucleolus was displaced,circuitous membrane curved and chromatin agglutination aggregated;the ultrastructures of mitochondrion and rough endoplasmic reticulum were damaged seriously;and the vasogenic cerebral edema and the intracellular cerebral edema were severe with constrictive capillary cavity with ischemia. Conclusions The more severe the ultrastructure is damaged after acute PADBS with SBI,the worse the prognosis of the patients is.

关 键 词：外伤 急性弥漫性脑肿胀 合并症 二次脑损伤 超微结构 预后 

分 类 号：R651.1[医药卫生—外科学]