创伤弥漫性脑肿胀患者脑室外引流术前后的CT灌注压变化

CTP changes of patients with post-traumatic diffuse brain swelling after external intraventricular drainage

目的探讨外伤后急性弥漫性脑肿胀（PADBS）侧脑室外引流术治疗前后的脑血流动力学的变化。方法回顾性分析24例单纯性弥漫性脑肿胀患者,包括非手术治疗组与脑室外引流组各12例。患者在伤后4-5 h内首次行脑CT灌注（CTP）检查,7 d后复查CTP,对比分析两组感兴趣区域治疗前后的灌注参数变化。6个月后随访,分析预后。结果脑室外引流组各感兴趣区域脑血流量（CBF）、脑血容量（CBV）及平均通过时间（MTT）治疗前后差值比非手术治疗组增加,有统计学意义（除小脑区MTT及白质区MTT P〈0.1外,其余各区参数P〈0.05）,预后优于保守组（P〈0.05）。结论对PADBS患者使用脑室外引流可以更好地改善脑灌注,提高患者生存质量。

Objective The cerebral hemodynamic chaoges pre- and post-ventricular drainage for post-traumatic acute diffuse brain swelling （PADBS） are discussed. Methods Twenty-four cases with traumatic diffuse brain swelling were analyzed retrospectively from January 2012 to April 2014 and all the cases were divided into non-surgical （12 cases） and external intraventricular drainage group （12 cases）. The first CT perfusion scan was completed within 4 - 5 h after trauma and re-scan was performed after 7 d. The changes of perfusion parameters of two groups in area- of-interest were analyzed and compared prior and post treatment. Results The differences of prior and post therapy of cerebral blood volume （CBV）, cerebral blood flow （CBF） and mean transit time （MTr） of the group treated by external ventricular drainage were increased more notably than those of non-surgical group, and the prognosis was better than that of non-surgical group. Conclusion External ventricular drainage may improve cerebral perfusion and increase the survival rate of the patients with PADBS.