CAJ | 학술논문

目的：研究不同损伤程度原发性脑干损伤的功能及病理变化特点。方法用家兔原发性脑干损伤分级模型，Ⅰ～Ⅳ组撞击能量逐渐增大，每组10只对照组5组。通过解剖肉眼观察、组织 HE 普通组织化学染色及电镜检测来研究原发性脑干损伤的病理学变化。结果Ⅰ组脑干损伤功能变化轻微，组织病理表现为局部散在蛛网膜下腔出血，软脑膜局部剥脱，脑干浅表层有少量点状出血，神经细胞水肿，髓鞘和轴索基本正常；Ⅱ组脑干损伤功能变化较明显，病理表现为蛛网膜下腔片状出血，脑干浅层少量点（片）状出血，神经细胞轻度肿胀和空泡化；Ⅲ组脑干损伤反应明显，表现为脑干厚层蛛网膜下腔出血，脑干浅层及深部多处点片状出血，神经细胞变性，轴索变性断裂、轴浆萎缩；Ⅳ组脑干损伤异常严重，出现长时间呼吸抑制，8／10动物死亡，病理表现为脑干被厚层蛛网膜下腔血肿包裹，脑干损伤累及全层，镜下可见多发性小出血灶，神经细胞仅残留的细胞核，髓鞘板层严重分层且断裂，轴索离断、崩解；对照组生理功能及病理无异常。结论随撞击能量增大，脑干损伤功能变化更明显，病理变化更严重，且损伤区域由浅层向深层变化。
목적：연구불동손상정도원발성뇌간손상적공능급병리변화특점。방법용가토원발성뇌간손상분급모형，Ⅰ～Ⅳ조당격능량축점증대，매조10지대조조5조。통과해부육안관찰、조직 HE 보통조직화학염색급전경검측래연구원발성뇌간손상적병이학변화。결과Ⅰ조뇌간손상공능변화경미，조직병리표현위국부산재주망막하강출혈，연뇌막국부박탈，뇌간천표층유소량점상출혈，신경세포수종，수초화축색기본정상；Ⅱ조뇌간손상공능변화교명현，병리표현위주망막하강편상출혈，뇌간천층소량점（편）상출혈，신경세포경도종창화공포화；Ⅲ조뇌간손상반응명현，표현위뇌간후층주망막하강출혈，뇌간천층급심부다처점편상출혈，신경세포변성，축색변성단렬、축장위축；Ⅳ조뇌간손상이상엄중，출현장시간호흡억제，8／10동물사망，병리표현위뇌간피후층주망막하강혈종포과，뇌간손상루급전층，경하가견다발성소출혈조，신경세포부잔류적세포핵，수초판층엄중분층차단렬，축색리단、붕해；대조조생리공능급병리무이상。결론수당격능량증대，뇌간손상공능변화경명현，병리변화경엄중，차손상구역유천층향심층변화。
Objective To study characters of pathology associated with functional alteration of primary brainstem injury (PBI) at different injury severities in rabbits .Methods Animal model of graded PBI was produced using rabbits .Animals were di‐vided into five groups ,group Ⅰ to Ⅳ with an increase of impact power ,10 cases in each group ,and the control group with 5 cases . The pathology characters of PBI were investigated combining dissection observation with unaided eye ,tissue HE histochemical stai‐ning and electron microscope .Results Slight brainstem injury were observed in group Ⅰ ,and pathological results showed regional subarachnoid hemorrhage (SAH) ,stripping of regional cerebral pia mater ,a few petechial hemorrhage in surface ,nerve cell edema , normal medulla sheath and axon roughly .The brainstem injuries were apparent in group Ⅱ ,and the pathological changes indicated SAH in sheet ,petechial and sheeted hemorrhage in surface ,and slight swelling and vacuoles in nerve cells .The brainstem injuries were observed obviously in group Ⅲ ,exhibiting thick SAH ,petechial and sheeted hemorrhage in surface and inside ,degeneration of nerve cells ,abruption of axon ,and atrophy of axoplasm .Eight of ten animals died of respiratory depression induced by brainstem in‐jury in group Ⅳ ,presenting thick hemorrhage in subarachnoid surrounding brainstem ,the whole brainstem injured ,microscopically with multiple small hemorrhage ,nerve cells only residual nuclei ,myelin lamellar severe stratification and fracture ,and axonal tran‐section ,disintegration .No abnormal pathological changes were shown in control group .Conclusion The impacts to brainstem with higher powers lead to more manifest functional and more severe pathological changes ,with an alternation of injury location from surface to deep .