局部脑血流量在少量基底节出血手术决策中的应用  

The analysis on application value of regional cerebral blood flow as a surgical indication of small volume basal ganglia intracerebral hemorrhage

作　　者：张卫民 高海晓 张兰 刘龙 王敏 王松 路萌 薛振生 库洪彬 ZHANG Weimin;GAO Haixiao;ZHANG Lan;LIU Long;WANG Min;WANG Song;LU Meng;XUE Zhensheng;KU Hongbin(Third Department of Neurosurgery,Xingtai Third Hospital,Xingtai,China)

机构地区：[1]河北省邢台市第三医院神经外科,邢台054000

出　　处：《中国神经精神疾病杂志》2023年第7期385-390,共6页Chinese Journal of Nervous and Mental Diseases

基　　金：邢台市重点研发计划自筹项目(编号:2022ZC105)。

摘　　要：目的分析血肿同侧内囊局部脑血流量(region cerebral blood flow,rCBF)在少量(15~30 mL)高血压性基底节出血(hypertensive basal ganglia hemorrhage,HBGH)手术决策中的应用价值。方法回顾性分析少量基底节出血患者的病历资料,以入院时CT灌注(CT perfusion,CTP)检查所测得的血肿同侧内囊区rCBF数值及内囊区发生坏死的阈值[150 mL/(kg·min)]为标准,分为高于阈值的轻度灌注不足组[rCBF≥150 mL/(kg.min)]和低于阈值的重度灌注不足组[rCBF<150 mL/(kg·min)],在两组中再根据患者是否手术,分别分为手术亚组和药物治疗亚组。对比两组中手术与药物治疗两亚组间患者治疗效果的差异,以及术前术后内囊区rCBF差异,评价rCBF在决策少量基底节脑出血患者手术指征中的应用价值。结果共纳入患者212例,轻度灌注不足组115例,重度灌注不足组97例。轻度灌注不足组手术亚组与药物治疗亚组比较,治疗有效、预后良好、术后内囊区rCBF数值分别为65.2%vs.63.2%、66.7%vs.67.3%、294(233,325)mL/(kg·min)vs.291(228,336)mL/(kg·min),差异无统计学意义(P>0.05)。重度灌注不足组手术亚组治疗有效、预后良好、术后内囊区rCBF数值均显著优于药物治疗亚组,分别为59.1%vs.37.7%、61.4%vs.39.6%、266(198,311)mL/(kg·min)vs.3215(146,258)mL/(kg·min),差异有统计学意义(P<0.05)。结论内囊区rCBF可作为少量高血压性基底节出血手术指征的标准,高于内囊区发生坏死的阈值无手术指征,低于阈值,有手术指征。Objective To analyze the value of regional cerebral blood flow(rCBF)as a surgical indication for minor(15~30 mL)hypertensive basal ganglia hemorrhage(HBGH).Methods The data of patients with minor HBGH were retrospectively analyzed.Based on the value of rCBF in the ipsilateral internal capsule area of hematoma measured by CT perfusion(CTP)at admission and the threshold of necrosis in the internal capsule area(150 mL/(kg·min)),the patients were divided into mild hypoperfusion group(rCBF≥150 mL/(kg·min))above the threshold,and severe hypoperfusion group(rCBF<150 mL/(kg·min))below the threshold.Within each group,patients were further divided into surgical subgroups and drug treatment subgroups based on whether they underwent surgery or not.The difference in treatment effect between the two subgroups of surgery and drug treatment,as well as the difference of rCBF in the internal capsule area before and after surgery were compared to evaluate the application value of rCBF in the surgical indications of patients with minor HBGH.Results A total of 212 patients were enrolled,including 115 patients in the mild hypoperfusion group and 97 patients in the severe hypoperfusion group.Compared with the drug treatment subgroup,the surgical subgroup in the mild hypoperfusion group showed effective treatment,favorable prognosis,and postoperative rCBF values in internal capsule;were 65.2%vs.63.2%,66.7%vs.67.3%,294(233,325)mL/(kg·min)vs.291(228,336)mL/(kg·min),respectively,with no statistically significant difference(P>0.05).The surgical subgroup in the severe hypoperfusion group showed effective treatment,favorable prognosis,and postoperative rCBF values in internal capsule compared to the drug treatment subgroup were significantly bette,with values of 59.1%vs.37.7%,61.4%vs.39.6%,266(198,311)mL/(kg·min)vs.215(146,258)mL/(kg·min),respectively,with statistically significant differences(P<0.05).Conclusion The rCBF in the internal capsule area can be used as a surgical indication for minor HBGH.There is no surgical indication i

关 键 词：内囊 局部脑血流量 手术指征 阈值 少量基底节脑出血 CT灌注 

分 类 号：R651.1[医药卫生—外科学]