动脉瘤性蛛网膜下腔出血后脑血管痉挛和脑低灌注的相关性分析  

Correlation analysis of cerebral vasospasm to cerebral hypoperfusion after aneurysmal subarachnoid hemorrhage

作　　者：林达[1] 冯栋侠[2] 高恒[2] 徐伟东[2] 周新民[2] 费小斌[2] 

机构地区：[1]东南大学医学院,南京210009 [2]东南大学微侵袭神经外科研究所,江阴214400

出　　处：《中国微侵袭神经外科杂志》2010年第8期337-340,共4页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的分析动脉瘤性蛛网膜下腔出血(aSAH)后脑血管痉挛及脑灌注异常的相关性。方法回顾性分析52例aSAH病人的临床资料。在出血后3～15d内均接受CT血管造影(CTA)和CT灌注成像(CTP)检查,了解大脑前动脉(ACA)和大脑中动脉(MCA)血管痉挛的严重程度,以及相关供血区域的脑灌注情况,对获取的参数进行统计学分析和比较。结果无脑血管痉挛23例,其中发生脑低灌注5例(21%)(位于脑分水岭区4例,在脑沟积血附近1例)。轻中度脑血管痉挛18例,其中存在相关供血区域脑低灌注7例(38%)。重度脑血管痉挛11例,其中发生相关供血区域脑低灌注9例(81%)。比较无脑血管痉挛与重度脑血管痉挛血管节段的血流灌注区域,在局部脑血流量(rCBF)和平均通过时间(MTT)两方面,差异均存在统计学意义(P<0.05)。结论重度脑血管痉挛是相关供血区域发生脑低灌注的高危因素。无明显脑血管痉挛的病人,在脑分水岭区和脑沟积血附近也可发生脑低灌注,可能与脑微血管痉挛有关。Objective To evaluate the correlation between cerebral vasospasm and cerebral hypoperfusion after aneurysmal subarachnoid hemorrhage （aSAH）.Methods The clinical data of 52 patients with aSAH was analyzed retrospectively.Combined computed tomography angiography （CTA） and computed tomography perfusion （CTP） was performed in all patients 3 to 15 days after hemorrhage to estimate the vasospasm degree of the anterior and middle cerebral artery as well as cerebral perfusion of related blood-supply areas.The parameters gained were analyzed and compared statistically.Results Of 23 patients with no cerebral vasospasm,hypoperfusion occurred in 5 patients （21%） including 4 in cerebral watershed areas and 1 in the region adjacent to the sulcal clots.Hypoperfusion occurred in 7 of 18 patients （38%） with mild to moderate cerebral vasospasm and in 9 of 11 patients （81%） with severe cerebral vasospasm.There were significant differences in regional cerebral blood flow and mean transit time between the areas supplied by vascular segments without and with severe cerebral vasospasm （P〈0.05）.Conclusions Severe cerebral vasospasm is the high risk factor for cerebral hypoperfusion in the related blood-supply areas.Cerebral hypoperfusion without vasospasm could be observed in the watershed areas and the region adjacent to sulcal clots,which may be related to cerebral microvascular spasm.

关 键 词：蛛网膜下腔出血 动脉瘤 破裂 血管痉挛 颅内 低灌注 

分 类 号：R743.35[医药卫生—神经病学与精神病学]