中华神经医学杂志
中華神經醫學雜誌
중화신경의학잡지
CHINESE JOURNAL OF NEUROMEDICINE
2009年
3期
295-301
,共7页
孙样荣%郭富强%陶克言%吴文斌%曾宪容%周波%代红源%余能伟
孫樣榮%郭富彊%陶剋言%吳文斌%曾憲容%週波%代紅源%餘能偉
손양영%곽부강%도극언%오문빈%증헌용%주파%대홍원%여능위
脑出血%CT灌注成像%血液动力学%神经功能缺损评分
腦齣血%CT灌註成像%血液動力學%神經功能缺損評分
뇌출혈%CT관주성상%혈액동역학%신경공능결손평분
Intracerebral hemorrhage%Computered tomography perfusion%Haemodynamic%Scandinavian stroke scale
目的 利用CT灌注成像技术(CTP)观察脑出血患者的脑血液动力学变化规律及对临床神经功能缺损评分(SSS)的影响.方法 对41例幕上脑出血患者于发病后5 h～14 d同步行头颅CT平扫和CTP检查,观察时间、血肿体积、水肿范围、发病期间的血糖水平、同步平均动脉压(MBP)对脑出血患者脑血液动力学的影响和这种血液动力学变化与脑出血患者SSS相关性.结果 (1)血肿周围水肿带内、水肿带外(距离水肿边缘1 cm内)、同侧皮层区间不同病理区域脑血流量(分别为CBF1、CBF2、CBF3)差异有统计学意义(P<0.05),且随时间呈波动性变化;CBF1、CBF2呈直线正相关关系(r=0.334,P=0.035),与CBF3无直线相关关系(r=0.027,P=0.870;r=0.142,P=0.383).另外水肿带内CBF1和脑血容量(CBV1)呈直线正相关关系(r=0.803,P=0.000),但与达峰时间(PT1)无相关关系(r=-0.52,P=0.752).(2)CBF1的下降程度与血肿体积、血肿周围水肿范围呈直线负相关关系(r=-0.501,P=0.001;r=-0.589,P=0.000),与发病期间的血糖水平、MBP无相关关系(r=0.141,P=0.386;r=0.014,P=0.930).(3)血肿周围灌注损伤范围(参数图灌注缺损范围-血肿范围,此范围内的CBF<20mL/100 g·min)与血肿体积、血肿周围水肿范围呈直线正相关关系(r=0.449,P=0.003;r=0.645,P=0.000),与发病期间的血糖水平、MBP无相关关系(r=-0.047,P=0.769;r=0.141,P=0.378).(4)脑出血患者同步的SSS与血肿体积、血肿部位、CBF的下降程度、CBV的下降程度呈相关关系(r=-0.418,P=0.007;r=0.542,P=0.000;r=0.376,P=0.017;r=0.312,P=0.051),与血肿最大平面的灌注缺损范围、水肿范围无相关关系(r=-0.283,P=0.073;r=-0.163,P=0.308).结论 (1)脑出血患者血肿周围水肿带内、外及同侧皮层血流减低均降低,但趋势不一致.(2)血肿周围水肿带内存在着缺血性损伤(CBF<20mL/100g·min),其范围和程度均血肿大小、水肿范围有关,随时间波动变化,但未达到统计学差异.(3)出血部位、血肿体积、血肿周围水肿带内脑灌注水平影响脑出血患者的SSS.
目的 利用CT灌註成像技術(CTP)觀察腦齣血患者的腦血液動力學變化規律及對臨床神經功能缺損評分(SSS)的影響.方法 對41例幕上腦齣血患者于髮病後5 h～14 d同步行頭顱CT平掃和CTP檢查,觀察時間、血腫體積、水腫範圍、髮病期間的血糖水平、同步平均動脈壓(MBP)對腦齣血患者腦血液動力學的影響和這種血液動力學變化與腦齣血患者SSS相關性.結果 (1)血腫週圍水腫帶內、水腫帶外(距離水腫邊緣1 cm內)、同側皮層區間不同病理區域腦血流量(分彆為CBF1、CBF2、CBF3)差異有統計學意義(P<0.05),且隨時間呈波動性變化;CBF1、CBF2呈直線正相關關繫(r=0.334,P=0.035),與CBF3無直線相關關繫(r=0.027,P=0.870;r=0.142,P=0.383).另外水腫帶內CBF1和腦血容量(CBV1)呈直線正相關關繫(r=0.803,P=0.000),但與達峰時間(PT1)無相關關繫(r=-0.52,P=0.752).(2)CBF1的下降程度與血腫體積、血腫週圍水腫範圍呈直線負相關關繫(r=-0.501,P=0.001;r=-0.589,P=0.000),與髮病期間的血糖水平、MBP無相關關繫(r=0.141,P=0.386;r=0.014,P=0.930).(3)血腫週圍灌註損傷範圍(參數圖灌註缺損範圍-血腫範圍,此範圍內的CBF<20mL/100 g·min)與血腫體積、血腫週圍水腫範圍呈直線正相關關繫(r=0.449,P=0.003;r=0.645,P=0.000),與髮病期間的血糖水平、MBP無相關關繫(r=-0.047,P=0.769;r=0.141,P=0.378).(4)腦齣血患者同步的SSS與血腫體積、血腫部位、CBF的下降程度、CBV的下降程度呈相關關繫(r=-0.418,P=0.007;r=0.542,P=0.000;r=0.376,P=0.017;r=0.312,P=0.051),與血腫最大平麵的灌註缺損範圍、水腫範圍無相關關繫(r=-0.283,P=0.073;r=-0.163,P=0.308).結論 (1)腦齣血患者血腫週圍水腫帶內、外及同側皮層血流減低均降低,但趨勢不一緻.(2)血腫週圍水腫帶內存在著缺血性損傷(CBF<20mL/100g·min),其範圍和程度均血腫大小、水腫範圍有關,隨時間波動變化,但未達到統計學差異.(3)齣血部位、血腫體積、血腫週圍水腫帶內腦灌註水平影響腦齣血患者的SSS.
목적 이용CT관주성상기술(CTP)관찰뇌출혈환자적뇌혈액동역학변화규률급대림상신경공능결손평분(SSS)적영향.방법 대41례막상뇌출혈환자우발병후5 h～14 d동보행두로CT평소화CTP검사,관찰시간、혈종체적、수종범위、발병기간적혈당수평、동보평균동맥압(MBP)대뇌출혈환자뇌혈액동역학적영향화저충혈액동역학변화여뇌출혈환자SSS상관성.결과 (1)혈종주위수종대내、수종대외(거리수종변연1 cm내)、동측피층구간불동병리구역뇌혈류량(분별위CBF1、CBF2、CBF3)차이유통계학의의(P<0.05),차수시간정파동성변화;CBF1、CBF2정직선정상관관계(r=0.334,P=0.035),여CBF3무직선상관관계(r=0.027,P=0.870;r=0.142,P=0.383).령외수종대내CBF1화뇌혈용량(CBV1)정직선정상관관계(r=0.803,P=0.000),단여체봉시간(PT1)무상관관계(r=-0.52,P=0.752).(2)CBF1적하강정도여혈종체적、혈종주위수종범위정직선부상관관계(r=-0.501,P=0.001;r=-0.589,P=0.000),여발병기간적혈당수평、MBP무상관관계(r=0.141,P=0.386;r=0.014,P=0.930).(3)혈종주위관주손상범위(삼수도관주결손범위-혈종범위,차범위내적CBF<20mL/100 g·min)여혈종체적、혈종주위수종범위정직선정상관관계(r=0.449,P=0.003;r=0.645,P=0.000),여발병기간적혈당수평、MBP무상관관계(r=-0.047,P=0.769;r=0.141,P=0.378).(4)뇌출혈환자동보적SSS여혈종체적、혈종부위、CBF적하강정도、CBV적하강정도정상관관계(r=-0.418,P=0.007;r=0.542,P=0.000;r=0.376,P=0.017;r=0.312,P=0.051),여혈종최대평면적관주결손범위、수종범위무상관관계(r=-0.283,P=0.073;r=-0.163,P=0.308).결론 (1)뇌출혈환자혈종주위수종대내、외급동측피층혈류감저균강저,단추세불일치.(2)혈종주위수종대내존재착결혈성손상(CBF<20mL/100g·min),기범위화정도균혈종대소、수종범위유관,수시간파동변화,단미체도통계학차이.(3)출혈부위、혈종체적、혈종주위수종대내뇌관주수평영향뇌출혈환자적SSS.
Objective To investigate the hemodynamic changes in patients with intracerebral hemorrhage (ICH) using CT perfusion (CTP) imaging and the relation between cerebral perfusion and the Scandinavian Stroke Scale (SSS) of the patients. Methods Forty-one patients with supratentorial ICH underwent plain CT scanning and CTP imaging at different times after ICH onset (from 5 h to 14 days). The impact of the time after ICH onset, hematoma volume, edema area, mean hlood pressure (MBP) and blood glucose on the hemodynamics of the patients was assessed, and the correlation between the SSS and the hemodynamic changes evaluated. Resnlts The cerebral blood flow in the edema area (CBF1), the peripheral area of the edema (CBF2, within 1 cm to the edema) and the distant cortical area from the hematoma (CBF3) showed significant differences (r=0.027, P=0.870) and fluctuated with time. CBF1 showed a positive linear relation with CBF2 (r=0.334, P=0.035), but neither of them was correlated to CBF3 (r=0.027, P=0.870;r=0.142, P=0.383). CBF1 also showed positive linear relations with relative cerebral blood volume (rCBV1) (r=0.803,P=0.000) and the peak time (PT1) (r=-0.52, P=0.752). The reduction of CBF1 was inversely correlated to the hematoma volume and the edema area (r=-0.501, P=0.001;r=-0.589, P=0.000), but not related with MBP or blood glucose (r=0.141, P=0.386;r=0.014, P=0.930). The area of ischemic injury (the ischemic area defined by CBF parameters-the hematoma area, edema area (r=0.449, P=0.003;r=0.645, P=0.000), but not to the MBP or blood glucose (r=-0.047, P=0.769;r=0.141,P=0.378). SSS was found to correlate to the volume and location of the hematoma and the reduction of CBF and CBV (r=-0.418, P=0.007;r=0.542, P=0.000;r=0.376, P=0.017;r=0.312, P=0.050), but not to the ischemic and edema area (r=-0.283, P=0.073;r=-0.163, P=0.308). Conclusion CBF is reduced in the edema area, peripheral area of the edema and the distant cortical area from the hematoma but showing different patterns of variation. Ischemic injury is present in the edema area around the hemotema, and its scope and severity is related with the hemotoma volume and the size of the edema area and may vary with time. The location and volume of the hematoma as well as the perfusion level in the edema area all affect the SSS of the patients.
