脑CT平扫低密度影联合CTA斑点征对自发性脑出血早期血肿增大的预测价值  

Predictive value of noncontrast computed tomographic hypodensities combined with computed tomographic angiography spot sign for hematoma enlargement in early stage of spontaneous cerebral hemorrhage

作　　者：李瑾[1] 顾双双[1] 王路娜[1] 张均[1] 王军[1] LI Jin;GU Shuang-shuang;WANG Lu-na;ZHANG Jun;WANG Jun(Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院,南京210008

出　　处：《内科急危重症杂志》2020年第6期469-471,共3页Journal of Critical Care In Internal Medicine

基　　金：南京市医学科技发展项目(No:YKK16074)。

摘　　要：目的:分析头颅CT平扫低密度影(HD)联合头颅CT血管造影(CTA)斑点征(SS)对于自发性脑出血早期血肿增大的预测意义。方法:回顾性分析285例自发性脑出血患者入院时头颅CT、CTA及发病24h复查头颅CT情况,根据头颅CT及CTA将患者分为4组:SS(-)HD(-)、SS(+)HD(-)、SS(-)HD(+)、SS(+)HD(+),血肿增大定义为血肿体积增加>33%或>6 mL。结果:24 h后复查头颅CT有64例患者出现血肿增大。4组间年龄、性别、高血压及糖尿病病史、入院时血压、格拉斯哥昏迷评分(GCS)及脑出血部位比较,差异无统计学意义(均P>0.05),但入院时4组患者脑出血量与出现血肿增大的例数比较,差异有统计学意义(均P<0.05)。其中SS(+)HD(+)组患者入院时出血量较大,24 h内出现血肿增大的病例数更多(61.5%)。CTA斑点征、CT平扫低密度影及二者联合出现均为脑出血早期血肿增大的独立危险因素。CT平扫低密度影敏感性较高,但二者联合表现出较高的特异性。结论:在脑出血早期,CTA斑点征联合CT平扫低密度影能协助急诊医师快速及较准确地进行脑出血血肿扩张危险分层。Objective:To analyze the predictive value of noncontrast CT hypodensities(HD)combined with CTA spot sign(SS)for hematoma enlargement in spontaneous cerebral hemorrhage.Methods:We retrospectively analyzed the imaging of 285 patients with spontaneous cerebral hemorrhage admitted to the Emergency Department.The noncontrast CT,CTA and CT 24 h after onset were performed.According to the CT and CTA imaging,the patients were divided into four groups:SS(-)HD(-),SS(+)HD(-),SS(-)HD(+),SS(+)HD(+).The hematoma enlargement is defined as an increase in hematoma volume>33%or>6 mL.Results:Sixty-four patients showed hematoma enlargement 24 h after head CT examination.There were no significant differences in age,gender,previous history(hypertension and diabetes),blood pressure at admission,GCS score and location among the groups(all P>0.05),but there were statistically significant differences in the amount of intracerebral hemorrhage and the number of cases with increased hematoma at admission among the four groups(all P<0.05).In the SS(+)HD(+)group,the volume of bleeding was greater,and the number of cases with hematoma enlargement within 24 h was more(61.5%).The SS,HD and the combination of SS and HD were independent risk factors for hematoma enlargement.HD had higher sensitivity,but the combination of SS and HD showed a higher specificity.Conclusion:In the early stage of cerebral hemorrhage,combined use of SS and HD can help emergency doctors to quickly and accurately carry out risk stratification of cerebral hemorrhage hematoma expansion.

关 键 词：自发性脑出血 CT低密度影 CTA斑点征 

分 类 号：R743.34[医药卫生—神经病学与精神病学]