不规则血肿形态的量化评价  

Quantitative evaluation on irregular shape of hematoma

作　　者：李卓星 褚晓凡[1] 窦汝香 邹良玉[1] 朱治山[3] 李刚[1] 曾文双[4] 魏巍[5] 

机构地区：[1]暨南大学第二临床医学院神经内科,深圳518020 [2]深圳市布吉人民医院内一科 [3]深圳市罗湖人民医院神经内科 [4]北京大学深圳医院特诊科 [5]深圳市中医院CT室

出　　处：《中华神经科杂志》2008年第5期335-338,共4页Chinese Journal of Neurology

基　　金：深圳市科技计划资助项目（200404006）

摘　　要：目的不规则血肿形态是脑出血血肿扩大的危险因素之一，用数学方法推算出血肿的不规则指数（R），尝试用R值对血肿的不规则形态进行客观和量化的评价。方法收集深圳市5家医院发病6h内行第1次头颅CT检查，48h内复查头颅CT的非手术脑出血的病例资料，共120例，分为2组：血肿扩大组31例；血肿无扩大组89例。用图像测量软件测量脑出血患者头颅CT最大血肿平面的周长（L）、面积（S）、直径（A）、横径（B），计算周长／面积比值（IMS），设为X；以边缘光滑的椭圆形作为参照物，计算出以A、B为长、短轴线的椭圆周长／面积比值（L1／S1），设为X1。用测量得出实际血肿的X值除以参照物规则椭圆的X1值（X／X1），该比值称为R值，以R值来评价血肿不规则的程度。采用统计学方法分析R值与血肿扩大的关系。结果120例脑出血患者中有31例患者发生血肿扩大，发生率为25．8％。R值越大，血肿的形态就越不规则，当R值≥1．3时，血肿的不规则形态渐显著。血肿扩大的发生率在R值≥1．3为36．7％，明显高于R值〈1．3时的18．6％（Χ^2=4．62，P=0．032）。结论R值可作为不规则血肿的评价工具。R值≥1．3时患者更易发生血肿扩大，是血肿扩大的危险因素。Objective To assess the irregular shape of hematoma with math methods, which is one of the risk factors of hematoma enlargement. Methods We reviewed images data of patients with spontaneous intracerebral hemorrhage treated nonsurgically who underwent initial computed tomography （CT） within 6 hours and repeated CT within 48 hours of onset. The area （S） , the circumference （L） , the greatest diameter （A） and the transverse diameter （B） of the greatest hemorrhage CT slice was measured. The formula X = L/S was used to calculate the value. We calculated the area （ S1 ） and the circumference （ L1 ） of the ellipse with A as its long diameter and B as its short diameter. The formula X1 = S1/L1 was used to calculate the value. We used formula R = X/X1 to assess the irregular hematoma shape. The relationships between hematoma enlargement and R was analyzed. Results Thirty-one patients （25.8%） showed enlarged hematomas after admission. The larger the value of R, the more irregular the shape of hematoma. When R ≥ 1.3, the shape of the hematoma was significantly irregular. 36. 0% patients with R≥ 1.3 had hematoma enlarged, compared with only 18.6% those with R 〈 1.3 （Χ^2 = 4. 62, P = 0. 032）. Conclusions The irregular shape index R can be used to assess the shape of a hematoma. A particularly high likelihood of hematoma enlargement is observed in patients with an irregularly shape index R≥1. 3.

关 键 词：脑出血 血肿 体层摄影术 X线计算机 危险因素 

分 类 号：R686[医药卫生—骨科学]