MRS对微创血肿清除术后的评估研究

MRS study for the intracerebral hemorrhage with micro-damage puncture

目的观察脑出血患者保守治疗及微创血肿清除术治疗后的磁共振波谱(MRS)表现,探讨血肿周围脑组织改变及微创血肿清除术的临床价值。方法将20例高血压性脑出血患者随机分为2组,微创血肿清除手术组(微创组)和保守治疗组(对照组)各10例,所有病例均于发病后9～11d行常规MR及MRS检查。结果对照组血肿周围NAA/Cr值与对侧相应区的NAA/Cr值有显著性差异(P<0.01),前者较后者降低(12.6±7.4)%,其中4例可见到明确的乳酸峰;微创组血肿周围NAA/Cr值与对侧相对应区的NAA/Cr值亦有显著性差异(P<0.05),前者较后者降低(7.4±6.8)%;微创组血肿周围NAA/Cr值与对照组有显著性差异(P<0.05)。结论血肿周围NAA/Cr降低反映了血肿周围神经元损伤;微创血肿清除术能改善脑出血后的脑水肿形成。

Objective To observe the signs of the intracerebral hemorrhage （ICH） patient with conservative therapy and micro-damage puncture by magnetic resonance spectroscopy （MRS）, trying to investigate the changes of brain tissue around hemorrhage and the clinical value of micro-damage puncture. Methods Twenty patients with ICH were divided into micro-damage puncture group （ 10 cases） and control group （ 10 cases） randomly. All patients were performed routine MR and MRS examinations in the nine to eleven days af- ter the symptom onset. Results The difference of the perihematomal NAA/Cr value between the focus side and the contralateral corresponding side was significant in the control group（P〈0. 01 ）, and the focus side decreased （12. 6 ± 7. 4）% as compared with the contralateral corresponding side, four could be seen the obvious Lac peak among all patients. There was statistically significant difference in the perihematomal NAA/Cr value between the focus side and the contralateral corresponding side in the micro-damage puncture group （P〈 0. 05）, and the focus side decreased （7.4 ± 6. 8） %. There was statistically significant difference in the perihematomal NAA/Cr value between the control group and micro-damage puncture group （P〈0.05）. Conclusions MRS showed that the NAA/Cr decreased around hemorrhage. Under a certain premise it reflected the decrease of neurons around the hemorrhage. The micro-damage puncture could reduce the formation of brain edema after ICH.