CT灌注结合脑卒中量表评分对脑出血临床预后的评估

The appraisal of CT perfusion imaging with NIHSS score for clinical prognosis of intracerebral hemorrhage

目的应用CT灌注成像(CTPI)研究高血压性脑出血(HICH)患者亚急性期血肿周围组织的血流灌注状态及其与血肿量、临床卒中量表评分等相关性,为指导临床治疗及预后评估提供有价值的信息。方法收集2011年1月至2012年12月收住玉溪市人民医院神经内科的36例HICH患者,保守治疗后2周内行CTPI。分别测量血肿区、边缘区、外层区及健侧镜像区的血流灌注参数值。采用美国国立卫生研究院卒中量表(NIHSS)对患者治疗前后进行神经功能缺损评分;治疗后行CT平扫复查及追踪观察,并进行相应统计分析。结果 36例HICH患者血肿边缘区组织局部脑血流量(rCBF)、局部脑血容量(rCBV)均较健侧镜像区明显减低,平均通过时间(MTT)明显延长,差异均具有统计学意义(均P<0.001);血肿区灌注缺损最严重(P<0.05)。少量组恢复率为36.36%,中等量组恢复率为14.29%,两组恢复率差异不具有统计学意义(P>0.05);恢复组治疗前NIHSS评分(10.50±5.12)分,坏死组评分(16.85±5.96)分,差异具有统计学意义(P<0.05)。结论 HICH亚急性期血肿周围组织存在低灌注损伤,其转归受多种因素综合影响,不能用单一指标衡量。

Objective To explore the changes of blood perfusion in brain tissue around the hematoma in subacute phase of hypertensive intracerebral hemorrhage （ HICH ） with CT perfusion image （ CTPI）, and its correlation with the hematoma volume, National Institutes of health stroke scale （ NIHSS ） scores, so as to provide the valuable information for intraeerebral hemorrhage patients to set individualized treatment plan and prognosis assessment. Methods Thirty-six patients with HICH from Department of Neurology of the People＇s Hospital of Yuxi city from January,2011 to December,2012 were collected, and CTPI was performed within two weeks after conservative treatment. The perfusion parameters of the hematoma, marginal, outer and health-side mirror areas were measured. The neurologic impairment was graded for the patients before and after the treatment by the NIHSS. The patients after conservative treatment were rechecked by non-contrast CT scan and with clinical follow-up observation, and corresponding statistics were performed. Results The regional cerebral blood flow（rCBF） and the regional cerebral blood volume（rCBV） of the tissue around hematoma were significantly lower than that of the health side mirror area and the mean transit time（MTY） was significantly prolonged, there was significantly statistical difference （ P 〈 0. 001 ） ; the perfusion defect of hematoma area was the most serious （ P 〈 0. 05 ）. The recovery rate in small and medium hematoma volume groups were 36. 36% and 14. 29% respectively, the difference of recovery rate was not statistically significant between the two groups（ P 〉 0. 05 ）. The NIHSS scores before treatment were 10. 50 ± 5. 12 in recovery groups, in necrosis group the scores were 16. 85 ± 5.96, the difference was statistically significant （P 〈 0. 05 ）. Conclusion There is a hypoperfusion area around the hematoma tissue in subaeute phase of HICH,the prognosis is determined by the integration of many factors and can＇t be evaluated by a single index.