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目的 研究脑干枪弹伤的超微改变及其分子水平的致死机理。方法 用一例颅外损伤与2例头部枪伤作对比,于死亡后25min切取其脑干部组织块,相当于弹道处主要取自中脑被盖部与脑桥的被盖部和延脑的第四脑室底深部灰质部的组织,进行透射电镜及扫描电镜观察。结果 (1)脑内的枪弹伤病理改变包括烧灼伤、冲击和压力伤等。(2)枪弹伤虽在中脑而病理改变波及整个脑干。(3)损伤特点是神经轴突最广泛和损伤严重,神经胶质纤维次之,神经元受损又次之。(4)轴突烧灼伤表现髓鞘、轴浆及其内线粒体浓缩、变性,轴浆、轴索水肿;冲击、压力伤呈现轴突扭曲、变形、融合、挤压、缺损、破(断)裂及错位,轴浆内容外流或缺失,轴索内线粒体、神经微丝和微管偏向一侧位等。结论 脑干网状结构严重广泛性神经轴索损伤可能与致死有着最重要关系。
Objective To study the ultrastructural changes of brain stem bullet wounds and the lethal mechanism at the molecular level. Methods One case of extracranial injury was compared with two cases of head gunshot wound. The brain stem tissue was cut off 25 minutes after the death, which was equivalent to the section of capitatum and medulla oblongata Four deep ventricles of the gray matter of the Ministry of organization, transmission electron microscopy and scanning electron microscopy. Results (1) Pathological changes of gunshot wounds in the brain include burns, shocks and pressure injuries. (2) although the bullet wound in the brain and pathological changes affect the entire brain stem. (3) Injury is characterized by the most extensive and serious neuronal axons, followed by glial fibrils, followed by neuronal damage. (4) axonal burning burns showed myelin, axoplasm and mitochondria concentration, degeneration, axoplasm, axonal edema; impact, pressure injury showed axon distortion, deformation, fusion, extrusion, Fissures and dislocations, outflow or loss of axoplasm contents, mitochondria in axons, neurofilaments and microtubules deflected to one side. Conclusion The extensive and extensive axonal injury of the brainstem reticular structure may be the most important factor in lethality.