320排CT脑灌注参数与非体外循环下冠状动脉旁路移植术后缺血缺氧性脑病相关性研究

The correlation between evaluation of cerebrovascular function by 320 dynamic volume CT and hypoxic-ischemic encephalopathy after coronary artery bypass graft

目的：探讨非体外循环下冠状动脉旁路移植术（off-pump coronary artery bypass grafting,OP-CABG）后患者缺血缺氧性脑病（hypoxic-isehemic encephalopathy,HIE）与320排动态容积CT脑灌注参数的相关性.方法：选取择期行OPCABG手术的患者,其中女性50例,男性225例,年龄36～79岁,平均年龄（62.68±7.83）岁.剔除其他神经系统合并症患者,其中HIE患者37例,未出现神经系统并发症患者217例.收集患者影像学、神经系统查体信息,录入数据库进行分析.结果：①本研究术后发生HIE发生率4.36％.②HIE两组间各种灌注参数变化率结果显示：颞叶rCBV、颞叶rCBF、枕叶rMTT、基底节rMTT、额叶Delay及基底节Delay变化率差异有统计学意义.③枕叶rMTT变化率最为敏感;以枕叶rMTT变化率ROC曲线结果显示：枕叶rMTT变化率10.13％为ROC的移动诊断界点.结论：脑灌注参数与术后发生HIE关系密切,本研究中枕叶rMTT为较敏感指标.

Objective：To prospectively investigate neurological complications after off-pump coronary artery bypass grafting （OPCABG）,including the incidence and the risk factors to study the correlation between 320 row dynamic volume CT cerebral perfusion parameters and the occurrence of neurological complications after OPCABG.Methods：A total of 275 consecutive patients female 50,male 225,mean age （62.68 ± 7.83） years scheduled for isolated OPCABG were evaluated.Results：①After OPCABG the incidence of HIE is 4.36％ ; ②The various perfusion parameters rate of change between the HIE and healthy groups statistical analysis showed that：the rate of change temporal lobe rCBV,temporal lobe rCBF,occipital lobe rMTT,basal ganglia rMTT,frontal lobe Delay phase,basal ganglia Delay phase had statistical significance.③Compared to other parameters,rTTP was most sensitive.ROC curves showed that the rate of change occipital lobe rMTT was a better predictor of the occurrence of HIE.The optimal rate of change occipital lobe rMTT in HIE was 10.13％ in this stuy.Initial.Conclusion：Close relationship between perfusion parameters rate and HIE after surgery,occipital lobe rMTT is more sensitive in this study.