质子磁共振波谱分析创伤性蛛网膜下腔出血腰大池持续引流患者脑代谢的变化  

Analysis of cerebral metabolic changes by hydrogen proton magnetic resonance spectroscopy in patients with lumbar continuous drainage of cerebrospinal fluid on traumatic subarachnoid hemorrhage

作　　者：吴海滨[1] 赵冬青[2] 王科[2] 

机构地区：[1]宁波大学医学院附属鄞州医院神经外科,315000 [2]浙江萧山医院神经外科

出　　处：《临床神经外科杂志》2016年第2期114-117,共4页Journal of Clinical Neurosurgery

基　　金：杭州市科技局项目(2013ZJXSYY02)

摘　　要：目的探讨通过质子磁共振波谱（1H-MRS）分析创伤性蛛网膜下腔出血腰大池持续引流患者脑内代谢物质的变化,评估腰大池持续引流对创伤所引起的蛛网膜下腔出血患者的临床疗效及预后。方法将2012年10月~2015年6月收治的80例创伤性蛛网膜下腔出血患者随机分为治疗组40例和对照组40例。治疗组患者除采用常规方法外,入院第3 d行经腰大池持续引流的治疗,对照组患者只采用常规方法治疗;两组患者分别于入院后第3、8、14 d行经颅多普勒检查脑血流变化和比较其临床疗效。两组患者第14 d行质子磁共振波谱分析额叶、基底节、枕叶NAA、Cho、Cr及NAA/Cr,Cho/Cr值的变化,并对各项指标进行统计学分析。结果治疗组患者脑血管血流速度、临床疗效和主要症状消失率明显优于对照组（均P〈0.05）。治疗组额叶、基底节区域、枕叶NAA/Cr较对照组明显上升,Cho/Cr数值较对照组降低（均P〈0.05）。结论经腰大池持续引流可以缓解创伤性蛛网膜下腔出血患者的脑血管痉挛,改善患者临床症状,1H-MRS对评估临床疗效及预后具有重要参考价值。Objective To explore by hydrogen proton magnetic resonance spectroscopy（1HMRS） in patients with lumbar continuous drainage of cerebrospinal fluid on traumatic subarachnoid hemorrhage（ t SAH） to analysis of cerebral metabolic changes. To evaluate the clinical efficacy and prognosis of patients with subarachnoid hemorrhage caused by trauma. Methods 80 patients who underwent traumatic subarachnoid hemorrhage of lumbar continuous drainage of cerebrospinal fluid from October 2012 to October 2015 were divided into the observation group and the control group（ 40 patients each） randomly. The observation group in addition to using the conventional method,be admitted to hospital the third heaven treated by continuous drainage of lumbar cistern. Patients of control group were only given routine treatment. After admission,two groups were 3,8,14 days to examination cerebral blood flow changes by Transcranial doppler and compared the clinical efficacy each other. Two groups of patients on day 14 of proton magnetic resonance spectroscopy analysis of the frontal lobe,basal ganglia,pillow leaf NAA,Cho,Cr and NAA / Cr,Cho / Cr value changes,the indexes were statistically analyzed. Results The observation group of patients with cerebral blood flow velocity, clinical efficacy and the main symptoms of the disappearance rate was significantly better than the control group,P 0. 05. The frontal lobe,basal ganglia area and occipital lobe NAA / Cr in the observation group were significantly higher than those in the controlgroup,and the / Cr Cho values were lower than those in the control group,P 0. 05. Conclusion Continuous drainage of lumbar can relieve cerebral vasospasm in patients with traumatic subarachnoid hemorrhage,improve the clinical symptoms,1H-MRS has important reference value for evaluating clinical curative effect and prognosis.

关 键 词：质子磁共振波谱 脑代谢 创伤性蛛网膜下腔出血 腰大池持续引流 

分 类 号：R651.15[医药卫生—外科学]