颅脑损伤患者CTP参数与CPP,ICP的关系及其预后预测价值

Relationship between CTP parameters and CPP,ICP in patients with craniocerebral injury and prognostic predictive value

目的探讨颅脑损伤患者移动CT灌注扫描(CTP)参数与脑灌注压(CPP)、颅内压(ICP)的关系及其预后预测价值。方法选取2020年1月—2022年1月承德市中心医院收治的180例颅脑损伤患者作为研究对象,以28 d死亡为结局事件,将其分为生存组(n=35)和死亡组(n=145)。统计两组CTP参数[局部脑血容积(rCBV)、局部脑血流量(rCBF)、血液通过组织的平均通过时间(MTT)]、CPP、ICP,Pearson分析各指标间相关性,Logistic回归方程分析死亡相关危险因素,受试者工作特征(ROC)曲线分析各危险因素预测死亡价值,卡普兰-迈耶(K-M)曲线分析不同CTP参数患者生存状况。结果①两组CTP参数、CPP、ICP、病情程度、血肿体积比较,差异有统计学意义(P<0.05);②颅脑损伤患者rCBV、rCBF与ICP呈负相关,与CPP呈正相关,MTT与ICP呈正相关,与CPP呈负相关(P<0.05);③Logistic回归方程显示,rCBV、rCBF、MTT是颅脑损伤患者预后影响因素(P<0.05);④rCBV、rCBF、MTT联合预测预后的曲线下面积(AUC)为0.929,优于单一预测价值;⑤rCBV、rCBF高表达患者生存率高于rCBV、rCBF低表达患者,MTT高表达患者生存率低于MTT低表达患者,差异有统计学意义(P<0.05)。结论颅脑损伤患者CTP参数与CPP、ICP及预后密切相关,可作为预后评估重要参考指标,指导临床诊治。

Objective To investigate the relationship between mobile CT perfusion scanning(CTP)parameters and cerebral perfusion pressure(CPP)and intracranial pressure(ICP)in patients with craniocerebral injury and prognostic value.Methods One hundred and eighty patients with craniocerebral injury admitted to Chengde Central Hospital from January 2020 to January 2022 were selected for the study and were divided into survival(n=35)and death groups(n=145)using 28 d death as the outcome event.CTP parameters[local cerebral blood volume(rCBV),local cerebral blood flow(rCBF),mean passage time of blood through tissue(MTT)],CPP,ICP,Pearson's analysis of correlation between indicators,Logistic regression equation analysis of death-related risk factors,subject operating characteristic(ROC)curve analysis of each risk factor to predict death in both groups value,and Kaplan-Meyer(K-M)curves to analyze the survival of patients with different CTP parameters.Results①Comparison of CTP parameters,CPP,ICP,degree of illness,and hematoma volume between the two groups showed statistically significant differences(P<0.05);②rCBV and rCBF were negatively correlated with ICP and positively correlated with CPP,and MTT was positively correlated with ICP and negatively correlated with CPP in craniocerebral injury patients(P<0.05);③Logistic regression equation showed that rCBV,rCBF,and MTT were prognostic influences in patients with craniocerebral injury(P<0.05);④The AUC of rCBV,rCBF,and MTT combined to predict prognosis was 0.929,which was better than the single predictive value;⑤The survival rate of patients with high expression of rCBV and rCBF was higher than that of patients with low expression of rCBV and rCBF,and the survival rate of patients with high expression of MTT was lower than that of patients with low expression of MTT,and the difference was statistically significant(P<0.05).Conclusion CTP parameters in patients with craniocerebral injury are closely related to CPP,ICP and prognosis,and can be used as an important reference index for prognostic assessment and to guide clinical diagnosis and treatment.