CTA和CTP点征在中等量高血压性基底节区出血超早期手术方式选择中的应用价值

Value of spot sign on CTA and CTP imaging in selecting ultra-early operative methods for patients with moderate hypertensive basal ganglia hemotoma

目的探讨CT血管成像(CTA)和CT灌注成像(CTP)点征在中等量(出血量30~60 ml)高血压性基底节区出血超早期手术方式选择中的应用价值。方法回顾性分析2016年2月至2019年7月收治的242例中等量高血压性基底节区出血的临床资料。118例完成颅脑CTA、CTP检查(观察组),124例未完成颅脑CTA、CTP检查(对照组)。观察组病人根据CTA、CTP检查结果选择手术方式:1项点征阳性采用开颅手术,2项点征均为阴性采用钻孔引流术。对照组病人根据对全麻手术的耐受性及知情同意情况选择手术方式:耐受性差或不同意开颅手术的病人采用钻孔引流术,耐受性尚可且不同意引流术的病人病人采用开颅手术。结果观察组引流术治疗有效率明显高于对照组(P<0.05),而观察组引流术后血肿增大率、病死率、颅内感染发生率较对照组均明显降低(P<0.05)。观察组开颅手术治疗有效率、术后血肿增大率、病死率、颅内感染发生率与对照组均无统计学差异(P>0.05)。结论联合应用CTA、CTP点征作为客观依据选择中等量脑出血超早期手术方式,可提高治疗有效率,降低术后血肿扩大、死亡及颅内感染的风险,改善病人预后。

Objective To explore the value of spot sign on CT angiography(CTA)and CT perfusion(CTP)imaging in selecting ultra-early operative methods for patients with moderate hypertensive basal ganglia hemorrhage(HBGH).Methods The clinical data of 242 patients with moderate HBGH who underwent surgery from February 2016 to July 2019 were retrospectively analyzed.One hundred and eighteen patients completed the CTA and CTP examination(observation group),124 did not(control group).The surgical method for patients in the observation group was chose according to the CTA and CTP examination results:the craniotomy was chose when one point sign was positive on the CTA and CTP imaging,and the drainage was chose when both point signs were negative.The surgical method for patients in the control group was chose based on the tolerance to general anesthesia and informed consent:the drainage was chose for patients with poor tolerance or disagreement with craniotomy,and the craniotomy was used for patients with acceptable tolerance and disagree with the operation.Results The effective rate of drainage treatment in the observation group was significantly higher than that in the control group(P<0.05),while the rate of hematoma and mortality,and the incidence of intracranial infection after drainage in the observation group were significantly lower than those in the control group(P<0.05).There was no statistically significant difference in the effective rate,postoperative hematoma enlargement rate,mortality rate,and the incidence of intracranial infection between both the groups(P>0.05).Conclusion The combination of CTA and CTP points as an objective basis to select the surgical method for moderate HBGH can improve the treatment efficiency,reduce the risk of postoperative hematoma expansion,death and intracranial infection,and improve patient prognosis.