自发性脑出血患者锥颅血肿引流术后的磁共振波谱研究  

Magnetic Resonance Spectroscopy on Patients with Spontaneous Intracerebral Hemorrhage after Hematomas Drainage by Twist-Drill Craniotomy

作　　者：姚国杰[1] 陈琼[1] 濮捷[2] 李成才[1] 韦可[1] 肖炳祥[1] 龚杰[1] 徐国政[1] 

机构地区：[1]广州军区武汉总医院神经外科,中国人民解放军神经外科研究所,武汉430070 [2]广州军区武汉总医院神经内科,中国人民解放军神经外科研究所,武汉430070

出　　处：《华中科技大学学报（医学版）》2015年第4期455-459,共5页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

摘　　要：目的观察自发性脑出血患者保守治疗与微创锥颅血肿引流术治疗后磁共振波谱的变化,从影像学上探讨微创锥颅血肿引流术在脑出血治疗中的应用价值。方法 37例自发性脑出血患者,20例接受微创锥颅血肿引流术,17例采用内科保守治疗,所有患者均进行血肿量和水肿量的计算,比较7d血肿/水肿清除率,所有患者均于发病后10~14d行常规磁共振（MRI）及磁共振波谱成像（MRS）检查。结果微创锥颅血肿引流术组的7d血肿清除率为87.5%,治疗前后水肿体积改变不明显,对照组7d血肿清除率为37.0%,水肿量明显高于治疗前。对MRS结果进行分析,锥颅微创组血肿侧区域NAA/Cr为（1.269±0.458）,与对照组NAA/Cr值（0.958±0.356）比较,差异有统计学意义（P〈0.05）。结论微创锥颅血肿引流术血肿清除率高,可明显减轻脑水肿发生。MRS数据客观地评价了疾病转归与预后,证实微创锥颅血肿引流术可明显减轻脑出血后患者继发性脑损伤的发生。Objective To observe the differences of magnetic resonance spectroscopy（MRS）between conservative therapy and hematomas drainage by twist-drill craniotomy on patients with spontaneous intracerebral hemorrhage（ICH）,and to discuss the effect and value of twist-drill craniotomy hematomas drainage on ICH patients.Methods In 37 patients with ICH,20 of whom were treated with twist-drill craniotomy hematomas drainage and 17 of whom were treated with conservative therapy,hematoma volume and edema volume were calculated and 7-day hematoma/edema clearance rates compared.All patients received regular MRI and MRS examination 10-14 days after morbidity.Results Seven-day hematoma clearance rate of the skull-drilling group was 87.5%.The change in edema volume before and after treatment was unremarkable.The 7-day hematoma clearance rate of the control group was 37.0%.The edema volume after treatment was significantly higher than that before（P0.05）.The analysis of MRS showed that the NAA/Cr of the skull-drilling group was（1.269±0.458）and that of the control group was（0.958±0.356）,with significant difference（P0.05）.Conclusion Twist-drill craniotomy hematomas drainage results in high hematoma clearance rate and significantly reduces the occurrence of cerebral edema.Using MRS data can evaluate the disease recovery and prognosis.Twist-drill craniotomy hematomas drainage significantly reduces the occurrence of secondary craniocerebral injury on patients with ICH and improves prognosis.

关 键 词：自发性脑出血 脑水肿 微创锥颅血肿引流术 磁共振波谱分析 

分 类 号：R743.34[医药卫生—神经病学与精神病学]