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

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腑肿胀合并小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(G0S)：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，毛细血管扩张允血。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。

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

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.