急性脑出血患者颅内血肿及其周边区局部脑血流量与躯体感觉神经诱发电位的研究

目的研究急性脑出血患者血肿区、周边区和对侧脑组织局部脑血流量以及躯体感觉神经诱发电位(si-matosensoryevokedpotential,SSEP)的变化。方法利用单光子发射计算机断层(singlephotonemissioncomputedtomo-graphy,SPECT)显像技术检查25例急性基底核区出血患者,根据中国卒中评分分型,轻型组16例,中型组9例,发病后1~5d、13~19d各做1次SPECT检查。采用感兴趣区模型分析法,分别于局部脑血流量(regionalcerebralbloodflow,rCBF)减低区的中心和其周围额顶叶、小脑中心及上述区域的对侧镜像区做放射性摄取计数,并计算病变侧与对侧放射性计数的摄取比(R),同时测定两组患者的SSEP各波潜伏时。结果两组患者行第1、2次SPECT检查时,血肿区病变侧放射性计数均显著低于对侧(P<0.01)。第1、2次检查时两组患者病变侧血肿区放射性计数均低于周边区(P<0.01)。病变对侧小脑的放射性计数低于病变侧,差异有显著性意义(P<0.01)。轻型组患者病变侧SSEP各波在P40、N60潜伏时及中型组患者病变侧SSEP各波在P25、N30、P40、N60潜伏时均较相应的对侧延长,差异有显著性意义(P<0.05);中型组患者病变侧SSEP各波在P25、N30、P40、N60潜伏时较轻型组相应波的潜伏时长,差异有显著性意义(P<0.05)。结论急性脑出血患者血肿区及其周边区的rCBF下降,血肿对侧小脑的血流量亦有下降,而且血肿侧的中枢神经系统功能有明显损害。

Study of Regional Cerebral Blood Flow Around Hematoma and Somatosensory Evoked Potential in Acute Cerebral Hemorrhage

Objective To study the dynamic change of regional cerebral blood flow (rCBF) around hematoma,and the change of somatosensory evoked potential (SSEP) in acute cerebral homorrhage (ACH).Methods A total of 25 patients with acute basal ganglia hemorrhage were divided into two groups according to the Chinese Stroke Scales,16 patients were in mild lesion group,and the other 9 patients were in moderate lesion group.~ 99m Tc-ECD SPECT were performed at 3 and 16 days after onset of the disease.The method of region of interesting (ROI) was applied to measure the uptake counts in the core of hematoma,frontoparietal region around the lesion,the center of cerebellum and their enantiomorphs in the contralateral hemisphere respectively.And the ratio of uptake counts of both sides was calculated.SSEPs of the patients in both groups were also measured at the same time.Results In the two lesion groups the radioactivity counts in the core of hematoma of the lesion side in the two times SPECT were obviously lower then those of their contralateral hemispheres respectively (P<0.01),but there was no significant difference between both side peripheral areas;and the radioactivity counts in the core of hematoma were lower then those in the peripheral area respectively (P<0.01).The radioactivity counts in the cerebellum of lesion side were lower than those of their contralateral hemispheres respectively (P<0.01).The SSEPs of lesion sides of patients in the mild group in P40 and N60 incubation phases,and in the moderate group in P25,N30,P40 and N60 incubation phases were obviously longer than those of their contralateral hemispheres respectively (P<0.05);The SSEPs of lesion side of patients in the moderate group in P25,N30,P40 and N60 incubation phases were obviously longer than those in the mild group (P<0.05).Conclusion The rCBF of hematoma and its peripheral area in patients with ACH significantly decreases,and it also declined in the contralateral cerebellum;the function of the nervous system in the lesion side is obviously damaged.