多模式CT在脑出血患者中的应用及CTP对其血流动力学及缺血半暗带的评估价值

Application of multimodal CT in patients with cerebral hemorrhage and the evaluation value of CTP in hemodynamics and ischemic penumbra

目的研究多模式CT在脑出血患者中的应用及CTP对其血流动力学及缺血半暗带的评估价值。方法选取2016年1月-2019年1月本院【石河子市人民医院】收治的60例脑出血患者,所有患者在入院后3 d内行多模式CT,并计算出梗死核心区、缺血半暗带和检测健康区的脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、平均达峰时间(TTP)以及梗死核心区与缺血半暗带MTT、TTP、CBF、CBV的比值rMTT、rTTP、rCBF、rCBV,并进行分析。比较发病5-10 h具有缺血半暗带患者进行溶栓治疗和常规治疗前后缺血半暗带灌注差别。结果缺血半暗带区CBF、CBV显著高于健康侧,TTP、MTT显著低于健康侧(P<0.05)。梗死核心区CBF、CBV显著低于健康侧,TTP、MTT显著高于健康侧(P<0.05)。缺血半暗带比值rCBF、rCBV显著高于梗死核心区,rTTP、rMTT显著低于梗死核心区(P<0.05)。溶栓治疗后,缺血半暗带rCBF显著低于治疗前,rTTP、rMTT显著高于治疗前,(P<0.05)。常规治疗后,缺血半暗带rCBF、rTTP、rMTT显著高于治疗前(P<0.05)。结论多模式CT检查对于脑出血患者应用较好,同时在多模式CT下,CTP可以有效观察血流动力学的改变,精准显示出血部位,准确区分梗死核心区和缺血半暗带。

Objective To study the application of multimodal CT in patients with cerebral hemorrhage and the value of CTP in the evaluation of hemodynamics and ischemic penumbra.Methods Sixty patients with cerebral hemorrhage in our hospital from January2016 to January 2019 were enrolled for multimodal CT within 3 days after admission.The cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT),time to peak(TTP)in infarct core area,ischemic penumbra and healthy areas.The ratio of MTT,TTP,CBF,CBV between infarct core area and ischemic penumbra were calculated and analyzed,namely r MTT,rTTP,rCBF,rCBV.The difference between ischemic penumbra perfusion in patients with ischemic penumbra before and after thrombolytic therapy and conventional treatment during the onset of 5-10h was compared.Results The CBF and CBV were significantly higher in ischemic penumbra zone than in healthy side,while the TTP and MTT were significantly lower than the healthy side(P<0.05).The CBF and CBV in the infarct core area were significantly lower than those in the healthy side,and TTP and MTT were significantly higher than the healthy side(P<0.05).The ratios of ischemic penumbra zone in r CBF and r CBV were significantly higher than in infarct core area,but r TTP and r MTT were significantly lower than the infarct core area(P<0.05).After thrombolytic therapy,rCBF in ischemic penumbra was significantly lower than that before treatment,and r TTP and r MTT were significantly higher than those before treatment(P<0.05).After conventional treatment,rCBF,rTTP,and r MTT in the ischemic penumbra were significantly higher than before treatment(P<0.05).Conclusions Multi-mode CT examination is better for patients with cerebral hemorrhage.At the same time,with the multi-mode CT,CTP can effectively monitor the changes of hemodynamics,accurately display the bleeding site,accurately distinguish the infarct core area and the ischemic penumbra.