高血压性脑出血急性期脑灌注显像的研究

SPECT brain perfusion imaging in acute stage of hypertensive intracerebral hemorrhage

目的 研究高血压性脑出血 (HCH)急性期 (72h内 )血肿周围及远隔区域的脑血流量 (rCBF)变化。方法 对30例HCH患者行发病后 2 4h内CT显像及发病后 72h内脑灌注显像 (SPECT) ,计算出血量及水肿量 ,对rCBF进行半定量分析 ,并进行 72h内临床和SPECT评分及发病后第 4周的日常生活能力评分 (BI)。结果 (1)脑水肿在脑出血后 2 4h内产生 ,并且早期水肿程度与出血量及血流灌注缺损容积 (FDV)呈显著相关 (r分别为 0 .86 85和 0 .35 6 2 ,P <0 .0 1)。 (2 )脑出血后血肿周边及双侧大脑半球血流量均显著降低。 (3)急性期SPECT总评分与相应的临床功能缺损评分呈直线相关 (r=0 .87,P <0 .0 1) ,与 4周时的BI呈直线负相关 (r=- 0 .82 ,P <0 .0 1)。结论 (1)脑水肿在脑出血后 2 4h内产生 ;(2 )rCBF与出血量及出血部位有关 ;(3)脑出血急性期血肿周边也存在着缺血半暗带。

Objective To investigate the changes of regional cerebral blood flow (rCBF) in acute stage of hypertensive cerebral hemorrhage (HCH).Methods Thirty patients underwent CT within 24 hours and SPECT within 72 hours after onset of HCH.Hematoma volumes and edema volumes were calculated using CT,semiquantitative rCBF and flow deficit volumes(FDV) were measured using SPECT.SPECT graded scale,neurological grading within 72 h after onset and Barthel Index (BI) at 4th week after onset were evaluated.Results (1) Brain edema formed within 24 hours after onset of HCH.There was strong linear correlation between edema volume and hematoma volume(r=0.8685,P<0.01)and also FDV (r=0.3562,P<0.01).(2) rCBF was significantly reduced in acute HCH.(3) Linear correlation between SPECT graded scale and neurological grading was significant (r=0.87,P<0.01).There was also negative linear correlation between SPECT graded scale and Bathel Index (r=-0.82,P<0.01).Conclusions (1) There was brain edema formation within 24 hours after onset of HCH;(2)The major factors affecting rCBF were hematoma volume and location;(3) Ischemia penumbra also existed in HCH.