早期颅脑影像学改变在缺氧缺血性脑病远期预后判断中的作用

Effect of early cerebral imaging changes on the long-term prognosis judgement of hypoxiaischemia encephalopathy

目的探讨颅脑影像学检查对心肺复苏术后缺氧缺血性脑病患者预后判断的价值。方法 17例心肺复苏术后确诊为缺氧缺血性脑病的患者。根据患者格拉斯哥预后评分(GOS)将患者分为恢复意识组(8例)和持续性植物状态组(9例)。分别于心肺复苏术后2周内、1月内、3月内进行脑电图(EEG)、经颅超声多普勒(TCD)、CT、磁共振成像(MRI)检查。结果恢复意识组和持续性植物状态组患者EEG及TCD检查检查均可出现β昏迷型脑电图、平坦波型脑电图、弥漫慢波、血流减慢等情况。而在CT或MRI检查时,恢复意识组患者影像学改变轻微局限,持续植物状态组2周内颅脑影像学检查可出现弥漫性脑水肿、蛛网膜下腔出血征象,1月内或3月内出现脑室旁白质大片异常信号且不断增多。结论颅脑影像学动态追踪检查可协助判断缺氧缺血性脑病远期预后。

Objective To investigate the value of cerebral imaging in predicting prognosisof hypoxia-ischemia encephalopathy after eardiopulmonary resuscitation. Methods A total of 17patients diagnosed as hypoxia-ischemia encephalopathy after cardiopulmonary resuscitation weredivided into the regain consciousness group （8 cases） and permanent vegetative state group （9cases） according to Glasgow outcome scale （GOS）. The electroencephalography （EEG）, transcranialdoppler （TCD）, CT or magnetic resonance imaging （MRI） were performed in 2 weeks, 1 monthand 3 months after onset of disorder. Results The patients in the two groups all showed Betacoma type electroencephalogram, flat wave type electroencephalogram, diffuse slow waves andslow blood flow in the EEG and TCD. The patients in the regain consciousness group only hadnormal or very mild and local lesion on CT or MRI, but the patients in the permanentvegetative state group had diffuse brain edema and subarachnoid hemorrhage in 2 weeks,increasing abnormal signal located periventricular white matter during the follow-up. ConclusionCerebral imaging can help in prognosticating the outcome of hypoxiaischemia encephalopathypatients.