脑出血血肿周边局部脑血流量经时动态变化及Xe—CT的改变

Study of regional cerebral blood flow around hematoma in intracerebral hemorrhage by Xenon-CT in different stage

目的研究脑出血血肿周边脑血流量的经时变化特点,分析其动态变化规律。方法对幕上出血的21例患者分别于发病后不同时间点(24 h 及7、14、21、28 d)进行 Xe-CT 检查,采用感兴趣区测定血肿巾心区、周边缺血区及其镜像区的局部腑血流量。结果血肿周边局部脑血流量在发病24 h 下降不明显(17.5%),7 d 时出现明显下降(34.2%),在14 d 降至最低(48.5%),在21 d 时有所恢复(40.5%),在28 d 时仍持续低灌注状态(38.5%)。各时间点与24 h 对比,差异具有统计学意义。结论脑出血急性期血肿周边存在脑血流量的下降,缺血程度在24 h 较轻,然后逐渐加重,至发病14 d 达到高峰,3周后缺血逐渐减轻,血肿周围的低灌注区可持续3～4周以上。

Objective To study the dynamic hematoma in acute intracerebral hemorrhage. Methods changes of regional cerebral flow （rCBF） around Xenon-CT was performed on 21 patients with intracerebral hemorrhage within 24 h, 7, 14, 21 and 28 days of onset. The rCBF in the core of hematoma and edema region around the hematoma were measured and compared with those in the uninvolved hemisphere. Results 24 h after the attack,the rCBF was slightly reduced by 17. 5% in the edema region around, while it was significantly reduced by 34. 2% seven days after the onset and dropped to the lowest point on the 14th day （ by 48.5% ） . The volume of rCBF on the 14th day was different significantly from those on other time points （ P 〈 0. 05 ）. Conclusion The penambra exists at prerihematoma area, where low perfusion lasts for 3 weeks after onset. The lowest rCBF occurs on the 14th day of onset.