CT脑灌注成像联合平均动脉压在重症颅脑外伤患者中的诊断价值及与预后的关系

Diagnostic value of CT perfusion imaging combined with mean arterial pressure in patients with severe craniocerebral trauma and its relationship with prognosis

目的探讨CT脑灌注成像(CTP)联合平均动脉压(MAP)在重症颅脑外伤患者中的诊断价值及与预后的关系。方法选择2019年4月至2021年2月南昌市第三医院神经外科收治的90例重症疑似颅脑外伤患者作为研究对象,所有患者入院后均常规行头颅CTP检查,以临床最终检查结果作为“金标准”,分析其诊断价值,并监测患者MAP水平。对患者进行6个月随访,并以格拉斯哥昏迷指数评分(GOS)作为预后评分标准,于患者治疗后1、6个月进行评估并完成相关性分析。结果90例重症疑似颅脑外伤患者经临床检查最终确诊62例,确诊率为68.89%。头颅CTP检查最终确诊57例,与“金标准”诊断符合率为85.56%(77/90),诊断灵敏度为85.48%(53/62),特异度为85.71%(24/28)。重症颅脑外伤脑血流灌注率(CBF)、脑血容量(CBV)、MAP水平低于非重症颅脑外伤,差异有统计学意义(P<0.05)。平均通过时间(MTT)及对比剂达峰时间(TTP)长于非重症颅脑外伤,差异有统计学意义(P<0.05)。重症颅脑外伤患者GOS评分平均(3.13±0.63)分。相关性分析结果显示,重症颅脑外伤患者GOS评分与CBF、CBV、MAP水平呈负相关,与MTT、TTP呈正相关(P<0.05)。结论CTP用于重症颅脑外伤患者中均具有较高的诊断价值,与MAP联合检查可指导临床治疗,且与患者预后存在强相关性。

Objective To investigate the diagnostic value of CT perfusion imaging(CTP)combined with mean arterial pressure(MAP)in patients with severe craniocerebral trauma and its relationship with prognosis.Methods A total of 90 patients with severe suspected craniocerebral trauma who were admitted to the Department of Neurosurgery of the Third Hospital of Nanchang from April 2019 to February 2021 were selected as the research objects.All patients underwent routine head CTP examination after admission,and the final clinical examination results were used as"golden standard".The diagnostic value was analyzed and the MAP level was monitored.The patients were followed up for 6 months,and the Glasgow coma index score(GOS)was used as the prognostic scoring standard.The patients were evaluated at 1,6 months after treatment,and the correlation analysis was completed.Results Among 90 patients with severe suspected craniocerebral trauma,62 patients were finally diagnosed by clinical examination,with a diagnosis rate of 68.89%.57 patients were finally diagnosed by head CTP examination,and the coincidence rate with the"gold standard"diagnosis was 85.56%[(53^(+)24)/90].The diagnostic sensitivity was 85.48%(53/62),the specificity was 85.71%(24/28).The levels of cerebral blood perfusion rate(CBF),cerebral blood volume(CBV)and MAP in severe craniocerebral trauma were lower than those in non-severe craniocerebral trauma,and the differences were statistically significant(P<0.05).The mean transit time(MTT)and the time to peak contrast(TTP)were longer than those of non-severe craniocerebral trauma,and the differences were statistically significant(P<0.05).The average GOS score of patients with severe craniocerebral trauma was(3.13±0.63).The results of correlation analysis showed that the GOS score of patients with severe craniocerebral trauma was negatively correlated with the levels of CBF,CBV and MAP,and positively correlated with MTT and TTP(P<0.05).Conclusion CTP has high diagnostic value in patients with severe craniocerebral trauma.Combined examination with MAP can guide clinical treatment and has a strong correlation with the prognosis of patients.