高血压性脑出血后血肿周围组织的血流动力学改变及对预后的影响

目的 应用CT灌注成像(PCTI)和免疫比浊分析法检测高血压性脑出血后外周血、血肿液中细胞因子的表达变化与血肿周围脑组织内的血流动力学变化,并分析其对预后的影响.方法 采用螺旋CT对56例高血压性脑出血患者行常规CT和PCTI检查,定量分析血肿周围与对侧相应区的脑血流量(CBF)、脑血容量(CBV)、对比剂平均通过时间(MTT),比较急性期与亚急性期CBF、CBV和MTT的变化.检测外周血、血肿液中补体C_3和C_4的水平.结果 56例患者急性期患侧CBF、CBV、MTT分别为(19.3±3.1)ml/(min·100 g)、(1.4±0.4)ml/g、(16.5±3.1)s,健侧分别为(50.3±3.4)mU(min·100 g)、(2.4 4±1.1)ml/g、(4.8±2.6)s,两侧问各对应指标比较差异均有统计学意义(P<0.05).亚急性期患侧CBF、CBV、MTT分别为(29.7 4±2.1)ml/(min·100 g)、(1.9 4±0.6)ml/g、(8.94±2.7)8,健侧分别为(48.2±6_3)ml/(min·100 g)、(2.34±0.7)ml/g、(4.74±1.6)s,两侧各对应指标比较差异均有统计学意义(P<0.05).亚急性期CBF、CBV、MTT与急性期比较,差异有统计学意义(P<0.05.急性期和亚急性期补体C_3和C_4在外周血和血肿液中的含量比较差异均有统计学意义(P<0.05).急性期和亚急性期的水肿比值分别为0.9和0.4,差异有统计学意义(P<0.05).结论 脑出血后血肿周围脑组织存在脑血流量下降和脑灌注降低.脑PCTT技术能够定量分析脑出血后血肿周围脑组织内的血流动力学变化,从而为临床上治疗高血压性脑出血和估计预后提供有意义的信息.

The study on hemodynamics changes of the regions surrounding hematoma in pafients with hypertensive cerebral hemorrhage

Objective To the expression of cytokines assay in peripheral blood and hematoma fluid of hypertensive cerebral hemorrhage,and the hemodynamic changes in brain tissue around the hematoma by using perfusion computed tomography imaging(PCTT)and immune turbidimetric analysis and analyze its influence on prognosis.Methods Fifty-six cases of hypertensive intracerebral hemorrhage patients were inspected with conventional CT and PCTT,quantitative analysis of hematoma and the contralateral corresponding area around the cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time (MTT),comparing acute and subacute phase CBF,CBV,MTT change.Peripheral blood,hematoma fluid compiement C_3 and C_4 levels were detected.Results In 56 patients with acute phase ipsilateral CBF,CBV,MTT were(19.3 4±3.1)ml/(min·100 g),(1.4 4±0.4)ml/g,(16.5 4±3.1)s,respectively,and in eontralateral were(50.3 4±3.4)ml/(min·100 g),(2.4±1.1)ml/g,(4.8±2.6)s,the corresponding index difference between the two sides were statistically significant(P<0.05).Subaeute phase ipsilateral CBF,CBV,MTY were(29.7±2.1)ml/(min·100 g),(1.9±0.6)ml/g,(8.9±2.7)s,the in contralateral were (48.2±6.3)ml/(min·100g),(2.3±0.7)ml/g,(4.7±1.6)s,the corresponding index difference between the two sides were statistically significant(P<0.05).Subacute phase CBF,CBV,MTT compared with acute phase,the difference Wag statistically significant(P<0.05).Acute and subacute phase of complement C_3 and C_4 in peripheral blood and hematoma fluid content of the differences were statistically significant(P<0.05).Acute and subaeute phase of edema ratios were 0.9 and 0.4,the difference was statistically significant (P<0.05).Conclusions The cerebral blood flow and cerebral perfusion of the brain tissue amund hematoma after the cerebral hemorrhage are decreased.PCTI Can analyze the intracerebral hemodynamic changes of the brain tissue around hematoma after the cerebral hemorrhage,which is helpful to treat hypertensive cerebral hemorrhage and estimate its prognosis.