CT灌注成像在蛛网膜下腔出血后脑微循环改变中的临床应用研究

Application of CT perfusion imaging in detection of changes in cerebral microcirculation

目的用CT灌注成像(CTperfusion,CTP)来探讨蛛网膜下腔出血(subarachnoid hemorrhage,SAH)后脑微循环的改变及其与临床表现、脑血管痉挛(cerebral vasospasm,CVS)的关系。方法收集85例SAH患者和35例正常人作为前瞻性研究对象。对每例研究对象进行CTP检查,并记录其CTP相关参数-脑血流量(cerebral blood flow,CBF)、脑血容量(cerebral blood volume,CBV)及平均通过时间(meantransittime,MTT)。将研究对象分为正常组和SAH组,CVS组和非CVS(non-cerebral vasospasm,nCVS)组,症状型CVS组(symptomatic cerebral vasospasm group,sCVS)和无症状型CVS(asymptomatic cerebral vasospasm group,asCVS)组,Hunt-HessⅠ～Ⅱ级组和Ⅲ～Ⅴ级组,比较各组之间CTP参数的差异。结果SAH组的CBF值低于正常组,MTT值较正常组延长(P<0.05)。CVS组、sCVS组和Hunt-HessⅢ～Ⅴ级组的CBF值分别较nCVS组、asCVS组和Hunt-HessⅠ～Ⅱ级组的CBF值下降,MTT值较后者有延长(P<0.05)。7例MTT值为6.31～12.72s的患者在病程中出现迟发型缺血性神经功能障碍(delayed ischemic neurological deficit,DIND),其中2例偏瘫,1例死亡。结论SAH后脑微循环血流动力学的改变和临床表现及CVS有一定的联系,并且能够通过CTP来检查、发现。

Objective To observe the changes in cerebral microcirculation after subarachnoid hemorrhage （SAH） and to study its correlation with cerebral vasospasm （CVS）. Methods Eighty-five SAH patients and 35 controls, enrolled in this study as perspective study subjects, were divided into SAH group and control group, CVS group and non-CVS group （nCVS）, symptomatic CVS （sCVS） group and asymptomatic CVS （asCVS） group. All the subjects underwent CT perfusion （CTP） and the associated parameters, including cerebral blood flow （CBF）, cerebral blood volume （CBV） and mean transit time （MTT） , were recorded for final analysis. Results Compared to the control group, the CBF and MTF were significantly changed in SAH group （P 〈 0.05 ）. The CBF was lower while the MTT time was longer in SAH group than in control group. The CBF was lower in CVS, sCVS and Hunt-Hess III to V groups than in nCVS, asCVS and Hunt-Hess I to II groups （P 〈 0. 05 ）. Delayed ischemic neurological dysfunction （DIND） was found in 7 patients with a MTT time of 6. 31 to 12. 72 s, hemiplegia occurred in 2 of the patients, and 1 patient died. Conclusion Changes in microcirculation hemodynamics after SAH are correlated with CVS and can be detected during CTP.