应用CTP对不同时间段急性脑梗死患者缺血半暗带的临床分析  

Clinical analysis on the ischemic penumbra of acute cerebral infarction in different periods by CTP

作　　者：韩玺河[1] 邹梅[1] 郭淼[1] 王琳琳[1] 李燕[1] 刘学玲[1] 张晓莺[1] 

机构地区：[1]新疆生产建设兵团医院神经内科,乌鲁木齐830002

出　　处：《新疆医学》2016年第7期784-786,共3页Xinjiang Medical Journal

基　　金：兵团科技攻关计划(2012AB016)

摘　　要：目的分析不同时间段的急性脑梗死患者缺血半暗带的CT灌注特点。方法收集自2012年1月~2015年10月在新疆生产建设兵团医院神经内科收治的发病24 h内的急性脑梗死84例,急诊行一站式CT平扫、CTP、CTA检查,分析灌注参数及CTA结果,确定缺血半暗带（对比法r CBF=患侧CBF/健侧CBF）。比较发病时间分别在〈4.5 h、4.5~6 h及6~24 h的急性脑梗死患者缺血半暗带的差异。结果所有患者均获得满意的灌注图像。其中9例患者[脑干梗死2例,基底节、放射冠区点状梗死（≤1 cm2）7例]因无法识别明确的感兴趣区被剔除,最终纳入75例：其中发病〈4.5 h患者15例,发病4.5~6 h患者20例,发病6~24 h患者40例;在不同发病时间段各灌注参数值患侧与健侧比较大部分有显著差异;在不同时间段三组r CBF值存在显著差异（P=0.000）;发病在〈4.5 h患者r CBF均值为0.51±0.25,95%置信区间为0.37~0.65;〈4.5 h的患者组与4.5~6 h的患者组r CBF比较无统计学差异（P=0.132）,〈4.5 h的患者组与6~24 h的患者组r CBF比较有统计学差异（P=0.000）,4.5~6 h的患者组与6~24 h的患者组r CBF比较有统计学差异（P=0.005）。结论不同时间段的急性脑梗死患者缺血半暗带存在差异;发病4.5~6 h的部分患者也可能存在缺血半暗带,CTP可以评价筛选部分静脉溶栓患者。Objective To analyze on characteristics of the ischemic penumbra by CTP in acute cerebral infarction with different time periods.Methods Eighty-four patients having acute cerebral infarction and the symptoms onset within 24 hours who hospitalized in our department from January 2012 to october 2015 were selected and underwent one-stop CT and CTP-CTA of internal carotid system.The parameter maps and CTA were analyzed to diagnose the ischemic penumbra.Ischemic penumbra of the patients with onset time less than4.5h,or 4.5h to 6h or more than 6h were compared.Results Satisfying perfusion images were obtained in all patients.nine patients were excluded because they were not found abnormal region of interest.So there were 15 cases with less than 4.5h onset time,twenty cases were within 4.5-6h onset time and forty cases were in 6-24 h onset time.Most of parameter maps at both sides existed differences,Ischemic penumbra of three groups were significantly different in different periods（p =0.000）;Mean incidence in cases within 4.5h onset time was0.51±0.25,95% confidence interval was 0.37-0.65;r CBF existed statistical difference between cases within 4.5h onset time and those within 4.5-6h onset time（p =0.132）;There was no statistical difference between cases within 4.5-6h and cases with more than 6h onset time（p =0.000）.Conclusion Ischemic penumbra existed statistical difference in acute cerebral infarction with different periods;Some patients who have onset time in 4.5-6h maybe have ischemic penumbra,CTP can evaluate and diagnose some patients who have intravenous thrombolysis.

关 键 词：CT灌注成像 急性脑梗死 缺血半暗带 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R814.42[医药卫生—临床医学]