创伤性硬膜下血肿去骨瓣减压术后大脑皮层血流灌注研究

目的：探讨创伤性硬脑膜下血肿开颅去骨瓣减压术后短期内大脑皮层的血流灌注特征。方法15例创伤性硬脑膜下血肿患者于去骨瓣减压术后1周行颅脑320排动态容积CT扫描，于水平位选择颅骨缺损直径最大层面图像划定感兴趣区，分别计算颅骨缺损区和对侧镜像区皮层脑血流量（CBF）、脑血容量（CBV）和平均通过时间（MTT），采用配对 t 检验进行统计学分析比较。结果所有患者术后48 h内意识清醒，未遗留神经功能障碍，复查头颅CT血肿清除满意，无再次出血和颅内感染发生。颅骨缺损区皮层CBF和CBV的均值分别为91.12 ml？（100 g）-1？min-1和6.02 ml/100 g，明显高于对侧镜像区的均值69.22 ml？（100 g）-1？min-1和2.42 ml/100 g，差异有统计学意义。颅骨缺损区皮层的MTT与对侧比较差异无统计学意义。结论通过颅脑320排动态容积CT灌注扫描验证，创伤性硬脑膜下血肿开颅清除血肿去骨瓣减压术后患者的皮层脑组织血流灌注有增加的现象，为进一步病生理研究提供依据。

Research of blood perfusion in cerebral cortex for patients with traumatic subdural hematoma undergoing decompressive craniotomy

ObjectiveTo discuss blood perfusion features of cerebral cortex at short term follow-up after decompressive craniotomy for traumatic subdural hematoma. Methods 320 slice dynamic volume CT scans were performed for fifteen patient with traumatic subdural hematoma at 1week after decompressive craniotomy, and then, region of interest was delimited in horizontal position CT image at the plane with largest skull defect. Cerebral blood flow （CBF）, cerebral blood volume （CBV） and mean transit time （MTT） of cortex at the site under the skull defect and the contralateral mirror site were calculated respectively. Pairedt test was employed for statistical comparison.Results All patients had normal consciousnesses at 48 hours after surgery without neurological sequelae. Hematomas were removed completely without rebleeding and intracranial infection. Mean CBF and CBV of cortex under the skull defect were 91.12 ml·（100 g）-1？min-1and 6.02 ml/100 g respectively, which were more than those of 69.22 ml·（100 g）-1？min-1 and 2.42 ml/100 g at contralateral mirror site with statistical significance. The difference between MTTs of cortex at the site under the skull defect and the contralateral mirror site failed to reach statistical significance.Conclusion Blood perfusion of cortex examined by 320 slice dynamic volume CT perfusion scan will increase after decompressive craniotomy for traumatic subdural hematoma patients, of which the information is helpful for researches of relative pathophysiologic mechanism.