高血压脑出血后局部脑血流量与脑灌注压变化的相关性

Correlation between regional cerebral blood flow and cerebral perfusion pressure after hypertensive intracerebral hemorrhage

目的观察高血压脑出血后局部脑血流量(rCBF)与脑灌注压(CPP)变化情况,分析rCBF与CPP变化的关系。方法选取2018年1月~2019年12月我院收治的85例高血压脑出血患者作为高血压脑出血组,入院后均给予常规降压治疗;另选取同期收治的80例单纯高血压患者作为对照组。于患者入院当天,入院24h、48h监测rCBF、CPP水平;比较高血压脑出血患者各时间点rCBF、CPP水平;分析高血压脑出血后rCBF与CPP的关系。结果高血压脑出血组大脑同侧、对侧脑半球rCBF、CPP水平均低于对照组(P<0.05);高血压脑出血组入院24h、48h,同侧、对侧脑半球rCBF、CPP水平均高于入院当天,且入院48h的同侧、对侧脑半球rCBF、CPP均高于入院24h(P<0.05)。相关性检验结果显示,同侧、对侧脑半球rCBF差值与CPP差值均呈正相关(r分别为0.843、0.999,P<0.05);A组(CPP>106.6mmHg)、B组(CPP≤106.6mmHg)患者入院当天同侧、对侧脑半球rCBF水平比较,差异无统计学意义(P>0.05);入院24h、48h后,A、B组rCBF均较入院当天提高,且A组高于B组(P<0.05);A组入院后rCBF差值高于B组(P<0.05);回归分析结果显示,同侧、对侧脑半球rCBF水平变化会影响CPP的变化(OR>1,P<0.05)。结论高血压脑出血后rCBF与CPP变化有一定内在联系,早期持续监测高血压脑出血患者的rCBF、CPP变化对早期指导治疗高血压脑出血有积极意义。

Objective To observe the changes of regional cerebral blood flow(rCBF) and cerebral perfusion pressure(CPP) after hypertensive intracerebral hemorrhage, analyze the relationship between the rCBF and CPP. Methods From Jan 2018 to Dec 2019, 85 patients with hypertensive intracerebral hemorrhage who were received by our hospital were selected as hypertensive intracerebral hemorrhage group, all patients were given conventional antihypertensive treatment;80 patients with simple hypertension who were received by our hospital during the same period were selected as the control group. Monitored the levels of rCBF and CPP on the day of admission and 24 h, 48 h after admission;compared the levels of rCBF and CPP in patients with hypertensive intracerebral hemorrhage;analyzed the relationship between rCBF and CPP after hypertensive intracerebral hemorrhage. Results The levels of rCBF and CPP in the ipsilateral and contralateral cerebral hemispheres of the hypertensive intracerebral hemorrhage group were lower than those in the control group(P<0.05);in the hypertensive intracerebral hemorrhage group, the rCBF and CPP in the ipsilateral and contralateral cerebral hemispheres at 24 h, 48 h after admission were higher than the day of admission, and the rCBF and CPP in the ipsilateral and contralateral cerebral hemispheres at 48 h after admission were higher than 24 h after admission(P< 0.05). The results of the correlation test showed that there was a positive correlation between the rCBF difference in the ipsilateral cerebral hemisphere, the rCBF difference in the contralateral cerebral hemisphere and the difference in CPP(r=0.843、0.999, P< 0.05). Compared the rCBF of the ipsilateral and contralateral cerebral hemispheres at the day of admission of patients in group A(CPP >106.6 mmHg) and group B(CPP≤106.6 mmHg), the difference was not statistically significant(P>0.05);24 h, 48 h after admission, rCBF in group A and group B had increased compared with the day of admission, and group A was higher than group B(P<0.05);the rCBF difference after admission in group A was higher than group B(P<0.05);the results of regression analysis showed that changes in rCBF levels in the ipsilateral and contralateral cerebral hemispheres affected the changes in CPP(OR>1, P<0.05). Conclusion There is a certain internal relationship between rCBF and CPP changes after hypertensive intracerebral hemorrhage. Continuously monitored the changes in rCBF and CPP in patients with hypertensive intracerebral hemorrhage at the early stage has positive significance for the early guidance of treatment of hypertensive intracerebral hemorrhage.