CT灌注成像对急性脑梗死患者静脉溶栓治疗的指导作用

The Guidance Role of Computed Tomography Perfusion Imaging in Patients with Acute Cerebral Infarction on Thrombolytic Therapy

目的 探讨CT灌注成像对急性脑梗死患者静脉溶栓治疗的指导作用.方法 选取发病6h内的急性脑梗死患者30例,行颅脑CT灌注成像检查,观察静脉应用尿激酶溶栓前后病变区相对脑血流量（rCBF）、相对脑血容量（rCBV）、相对平均通过时间（rMTT）的变化,于溶栓前、后进行NIHSS评分.结果 急性脑梗死发病6h内CT灌注成像均发现与临床症状相对于的脑灌注异常区,表现为脑血流量（CBF）、脑血容量（CBV）降低,平均通过时间（MTT）延迟,表明存在缺血半暗带.溶栓后大部分患者脑灌注情况明显改善,梗死核心区rCBF,rCBV与溶栓前比较无统计学差异（P〉0.05）;缺血半暗带区rCBF显著增加（P＜0.01）,rMTT减小（P＜0.01）.溶栓后NIHSS评分显著降低（P＜0.05）.结论 急性脑梗死患者超早期行CT灌注成像能显示缺血半暗带,溶栓后缺血半暗带区脑灌注异常明显改善,对静脉溶栓治疗具有临床指导意义.

Objecti： To explore the guidance role of computed tomography perfusion imaging （CTPI） in patients with acute cerebral infarction on thrombolytie therapy. Methods Thirty patients with acute cerebral infarction within 6 hours after onset were included in our study. CTPI was performed on all patients before and after thrombelytie therapy, and the changes of relative cerebral blood flow（rCBF） , relative cerebral blood volume （rCBV） and relative mean transit time（ MTT ） on ischemic area were observed, and the changes of neurological function dedicit scale （ NIHSS ） before and after thrombolytic therapy evaluated. Results Abnormal perfusion changes corresponding to clinical symptoms were all found on CTPI in acute cerebral infarction patients within 6 hours after onset, including CBF and CBV decreased, MTr delayed, which indicate there was an ischemic penumbra. Follow-up CTPI showed that the cerebral perfusion improved in most cases, there was no significant difference of rCBF and rCBV on infarction core compared with that before thrombolytic （ P 〉 0.05 ） , the rCBF was signifi- cantly increased（ P 〈0.01 ） and rMTT was significantly decreased（ P 〈0.01 ） on ischemic penumbra after thrombolytic therapy. NIHSS after thrombolytic therapy was significantly decreased than that before thrombolytic therapy （ P 〈 0.05 ）. Conclusion CTPI may show ischemic penumbra within hyperacute cerebral infarction,abnormal perfusion changes is improved after thrombolytic therapy. CTPI has clinical guidance role on thrombolytic therapy.