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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 rule of peri-edema in acute stage of cerebral hemorrhage and the imaging changes before and after hematoma aspiration and drainage to explore the theoretical basis of the value of this surgical treatment. Methods Autologous blood-brain-lobe hemorrhage model was adopted in suckling pigs. The evolution of cerebral edema at 0, 5, 3, 24, 48 and 72 hours after hemorrhage was dynamically observed by MRI with 1.5T MRI software and compared with control group (500U injected thrombin). To observe the changes of CT and puncture before and after operation in supercelular hematoma aspiration and drainage in some patients with intracerebral hemorrhage. Results 1h after intracerebral hemorrhage, there was a high signal area around the hematoma, but no abnormalities were found in DwI. Dynamic MRI showed that the edema of the perifocal area reached the peak at 48h after hemorrhage. Control group O.5,3h edema light. 3h brain specimens can see the translucent area around the hematoma. 6h intracerebral hemorrhage in patients with CT obvious edema zone, puncture and drainage located in the hematoma surface, you can remove the clear liquid 5 ~ 11ml, test prompted serum composition, review CT showed hematoma edema shrink or disappear. Conclusion The early edema of cerebral hemorrhage is related to the clot contraction. Ultra-early hematoma aspiration and drainage can reduce cytotoxic cerebral edema.