重型颅脑外伤灌注CT结果与脑灌注压的相关性

Correlation of brain perfusion computed tomography results and cerebral perfusion pressure in patients with severe head trauma

目的探讨重型颅脑外伤患者灌注CT结果与脑灌注压监测结果的相关性。方法 50例重型颅脑外伤患者分为两组:T组28例,C组22例,入院时头颅CT平扫有明显异常。在行灌注CT时,同时监测平均动脉压(MAP)及颅内压(ICP),计算脑灌注压(CPP)。应用直线回归分析灌注CT参数[局部脑血容量(rCBV)、局部脑血流(rCBF)和平均通过时间(MTT)]与CPP的相关性。结果根据灌注CT结果,T组分为两个亚组:T1组,16例,灌注CT结果与CPP呈弱相关;T2组,12例,两者存在强相关。T1、T2和C组间的灌注CT参数均有明显差异。T1组的rCBF为(18.8±8.0)cm3.100g-1.min-1,明显低于T2组的(60.2±21.3)cm3.100g-1.min-1和C组的(48.3±11.0)cm3.100g-1.min-1(P<0.01)。T1、T2组灌注CT参数与相应CPP值之间均显著相关(P<0.01)。结论灌注CT结合ICP监测能提供有价值的评估脑血管自动调节功能是否完好的信息,有助于指导治疗。

Objective To investigate the correlation of brain perfusion computed tomography （CT） results and cerebral perfusion pressure（CPP） in patients with severe head trauma. Methods Perfusion CT results of 50 patients with head trauma were analyzed, who were divided into two groups of T（28 cases, severe head trauma with abnormal CT findings during admission） and C（22 cases,head trauma with normal CT findings during admission）. The patients underwent perfusion CT and MAP and ICP were measured at the same time; by which CPP was calculated. The correlation between perfusion CT results[regional cerebral blood volume（rCBV）, regional cerebral blood flow （rCBF） and MTT3 and corresponding CPP was analyzed using linear regression analysis. Results According to perfusion CT results, group T was divided into two subgroups of T1 （16 cases, characterized by a weak correlation between the perfusion-CT results and the corresponding CPP values） and T2（12 cases, characterized by a strong correlation between the perfusion-CT results and the corresponding CPP values）. The values of rCBV, MTT and rCBF were all significantly different among groups of T1 ,T2 and C and correlated to those of CPP（P〈0. 01）. The rCBF of group T1 was （18. 8±8. 0） cm^3. 100g^-1. min^-1 ,which was lower than（60. 2±21.3） cm3 .100g^-1 .min^-1 of group T2 and （ 48. 3 ± 11.0 ） cm^3 . 100g^-1 .min^-1 of group C （ P〈0. 01 ）. Conclusion Combined measurements of perfusion-CT and CPP can provide more informations for evaluating the cerebral vascular autoregulation function and guiding treatment.