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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 observe the effect of intrahepatic injection of heparin on hematoma volume and surrounding edema after porcine cerebral lobe hemorrhage. Methods Thirteen piglets were randomly divided into simple bleeding group and heparin group. In the former group, 2,5 ml arterial whole blood was injected into the right frontal lobe. In the latter group, 0.2 ml (500 U ) Heparin sodium. The dynamic images of T2-WI, 30-60min and 24hT2 * weighted imaging were obtained by dynamic imaging with 1.5T MRI. FLAIR imaging was performed with liquid attenuated retrograde rotation, and DWI showed lesions (including edema and Hematoma) volume changes, compared hematoma surrounding and contralateral hemisphere apparent diffusion coefficient (ADC) value difference, and observe the histopathological changes. Results T2 * WI showed that there was no significant change in the hematoma volume at 24 hours after hemorrhage (2.21 ± 0.28 cm3 vs 2.33 ± 0.30 cm3, P> 0.05) Significantly greater than 1h [(5.29 ± 0.98) cm3 (3.09 ± 0.38) cm3, P <0.01]. 24 hours when the hematoma increased in animals around the hematoma edema area to ADC value-based, but locally reduced; no change in hematoma volume were seen only in the peritumoral ADC value increased, without reducing the phenomenon. Histopathology showed that the volume of hematoma was (5.45 ± 0.96) cm3 in heparin group at 24 hours, which was significantly higher than that in hemorrhage (2.31 ± 0.22) cm3 (P <0.05). At the same time, both FLAIR imaging and DWI showed that the volume of lesion in heparin group increased significantly (P <0.05 or P <0.01). Conclusion Intrahematoma injection of heparin after intracerebral hemorrhage not only can not reduce the extent of edema around the hematoma, but also can lead to progressive bleeding, hematoma increased 24h, a large number of bleeding around the hematoma?