急性缺血性脑卒中取栓前后CT灌注成像与复发及认知功能的相关性分析  

Correlation between CT Perfusion Imaging and Recurrence and Cognitive Function before and after Thrombectomy in Acute Ischemic Stroke

作　　者：陈华[1] 张继[1] 张波[1] 张红霞[1] CHEN Hua;ZHANG Ji;ZHANG Bo(Taizhou People's Hospital,Jiangsu Taizhou 225300,China)

机构地区：[1]江苏省泰州市人民医院医学影像科,江苏泰州225300

出　　处：《河北医学》2022年第12期2052-2058,共7页Hebei Medicine

基　　金：江苏省第五期“333工程”培养资金资助项目,(编号:BRA2020193)。

摘　　要：目的:探讨急性缺血性脑卒中取栓前后的CT灌注成像结果与患者疾病复发及认知功能障碍的相关性。方法:选取2019年7月到2021年10月期间我院神经外科收治的急性缺血性脑卒中患者97例,所有患者均采用机械取栓术进行治疗,并采用64排螺旋CT机对所有患者取栓前后进行CTP检查,出院时对所有患者的认知功能进行评估,对比出现认知功能障碍和无认知功能障碍的患者的基线资料和取栓前后的rCBF、rCBV、rMTT水平。对所有患者进行至少6个月的随访,对比复发和未复发患者的基线资料和取栓前后的rCBF、rCBV、rMTT水平。并对rCBF、rCBV、rMTT与患者复发和认知功能障碍的相关性进行分析。结果:97例患者取栓后的rCBF、rCBV较取栓前显著升高,而rMTT显著降低,其中28例患者出现认知功能障碍,19例患者出现复发。认知功能障碍组和认知功能正常组患者取栓后的rCBF、rCBV均显著升高,认知功能正常组患者取栓后的rMTT显著降低,差异均具有统计学意义(P<0.05),同时认知功能正常组患者在取栓前及取栓后的rCBF、rCBV均显著高于认知功能障碍组,rMTT显著低于认知功能障碍组,差异具有统计学意义(P<0.05);复发组和未复发组患者取栓后的rCBF、rCBV均显著升高,rMTT显著降低,同时复发组患者在取栓后的rCBF、rCBV均显著高于未复发组,rMTT显著低于未复发组,差异具有统计学意义(P<0.05)。经过多因素Logistic回归分析后得到取栓前后rCBF、rCBV低水平,与取栓前后rMTT高水平是影响患者认知功能障碍的危险因素,而取栓后的rCBF、rCBV低水平与取栓后rMTT高水平是影响患者疾病复发的危险因素,差异均具有统计学意义(P<0.05)。结论:对于急性缺血性脑卒中患者,在取栓前后可通过CTP检查明确rCBF、rCBV、rMTT水平,为患者预后的评估提供可靠的参考依据。Objective:To investigate the correlation between CT perfusion imaging findings before and after embolization in acute ischemic stroke and patients'disease recurrence and cognitive impairment.Methods:97 patients with acute ischemic stroke treated in neurosurgery of our hospital from July 2019 to October 2021 were selected.All patients were treated with mechanical thrombectomy,and all patients were examined by 64 row spiral CT before and after thrombectomy.The cognitive function of patients with and without cognitive impairment was evaluated at discharge.The baseline data of patients with and without cognitive impairment and the levels of rCBF,rCBV and rmtt before and after thrombectomy were compared.All patients were followed up for at least 6 months to compare the baseline data of recurrent and non recurrent patients and the levels of rCBF,rCBV and rmtt before and after thrombectomy.The correlation between rCBF,rCBV,rmtt and recurrence and cognitive impairment was analyzed.Results:The rCBF and rCBV of 97 patients after thrombectomy were significantly higher than those before thrombectomy,while the rmtt was significantly lower.Among them,28 patients had cognitive impairment and 19 patients had recurrence.The rCBF and rCBV of patients with cognitive impairment and normal cognitive function increased significantly after thrombectomy,and the rMTT of patients with normal cognitive function decreased significantly(P<0.05).At the same time,the rCBF and rCBV of patients with normal cognitive function before and after thrombectomy were significantly higher than those of patients with cognitive impairment,and the rMTT was significantly lower than those of patients with cognitive impairment(P<0.05);the rCBF and rCBV in the recurrent group and the non recurrent group were significantly higher and the rMTT was significantly lower after thrombectomy.At the same time,the rCBF and rCBV in the recurrent group were significantly higher than those in the non recurrent group,and the rMTT was significantly lower than that in the non

关 键 词：急性缺血性脑卒中 血管内取栓 CT灌注成像 认知功能障碍 复发 

分 类 号：R743.3[医药卫生—神经病学与精神病学]