CTP在高血压性基底节区小量出血治疗方案评估中的价值

Value of CTP in evaluation of treatment of hypertensive basal ganglion hemorrhage

目的探讨CT灌注(CTP)成像在高血压性基底节区小量(<30 ml)出血治疗方案评估中的价值。方法 2011年4月至2016年5月收治高血压性基底节区小量出血254例,根据入院时脑CTP成像检查结果中血肿周围局部脑血流量(rCBF)分为轻度低灌注组[rCBF≥15 ml/(100 g·min);144例]和重度低灌注组[rCBF<15 ml/(100 g·min);110例];两组又根据治疗方法分为手术亚组和非手术亚组。发病28 d采用改良Rankin量表(mRS)评分评估疗效,0~3分为有效,4~5分为无效。结果轻度低灌注组:手术亚组入院后7 d rCBF与入院时无明显差异(P>0.05);非手术亚组入院后7 d rCBF与入院时也无明显差异(P>0.05)。重度低灌注组:手术亚组入院后7 d rCBF较入院时明显增高(P<0.05);非手术亚组入院后7 d rCBF与入院时无明显差异(P>0.05)。轻度低灌注组:手术亚组有效率(79.7%,59/74)与非手术亚组(77.1%,54/70)无统计学差异(P>0.05)。重度低灌注组:手术亚组有效率(64.9%,37/57)明显高于非手术亚组(41.5%,22/53;P<0.05)。结论 CTP成像可提供脑出血周围脑组织血流客观数据,为小量基底节区出血手术指征的把握有较好的指导意义。

Objective To explore the value of CT perfusion （CTP） imaging in evaluating the treatment of small amount （〈30 ml） of hypertensive basal ganglia hemorrhage （HGBH）. Methods Two hundred and fifty-four patients with small amount of HGBH were admitted to our hospital from April 2011 to May 2016. Those patients were divided into mild low perfusion [regional cerebral blood flow （rCBF） ≥ 15 ml/（100 g· min）; n=114] and severe low perfusion [rCBF〈15 ml/（100 g·min）; n=110] groups according to the rCBF around the hematoma in brain CTP imaging examination at admission. The two groups were redivided into surgery and non-surgery subgroups according to the treatment. Results Of patients in mild low perfusion group, the treatment method （surgery or conservative treatment） had no significant effect on rCBF 7 days after admission compared to that at admission （P〉0.05）. There was no significant difference in the curative rate between surgery and non-surgery subgroups of patients in mild low perfusion group （P〉0.05）. Of patients in severe low perfusion group, conservative treatment had no significant effect on rCBF 7 days after admission （P〉0.05）, but surgery significantly increased rCBF 7 days after admission compared to that at admission （P〈0.05）. The curative rate in surgery subgroup was significantly higher than that in non-surgery subgroup of patients in severe low perfusion group （P〈0.05）. Conclusion The CTP imaging is helpful to the selection of treatment for small amount of HBGH, because it can provide objective evidence of rCBF around the hematoma.