急性脑出血患者颅内血肿周边局部脑血流量的氙-CT研究  

Study of regional cerebral blood flow around hematoma in acute intracerebral hemorrhage by xenon-CT

作　　者：董强[1] 丁宏岩[1] 史朗峰[1] 韩翔[1] 傅建辉[1] 吕传真[1] 

机构地区：[1]复旦大学附属华山医院神经内科,上海200040

出　　处：《中华医学杂志》2004年第10期822-825,共4页National Medical Journal of China

基　　金：卫生部临床课题重点基金资助项目 (2 0 0 115 2 3 )

摘　　要：目的　利用氙 CT定量观察急性脑出血血肿周边局部脑血流量的变化 ,分析局部缺血持续的时间和程度。方法　对基底节区出血的 5例患者 (血肿量不超过 30ml) ,于发病 36h内和第13天行氙 CT检查 ,测定血肿中心区和周边水肿区及各自镜像区的血流量。结果　 (1) 5例患者均有高血压 ,平均血肿量 13ml± 7ml(6 4～ 2 3 7ml)。第一次检查的时间是发病后 2 3h± 6h(19～ 34h) ,复查时间是发病后 13d± 0 7d(12～ 14d)。 (2 )发病 36h内血肿区的平均血流量是 15ml·10 0 g-1·min-1± 8ml·10 0g-1·min-1,水肿区的平均血流量是 30ml·10 0g-1·min-1± 8ml·10 0g-1·min-1;发病第 13天左右血肿区的平均血流量是 9ml·10 0 g-1·min-1± 4ml·10 0 g-1·min-1,水肿区的平均血流量是 2 3ml·10 0g-1·min-1± 13ml·10 0g-1·min-1。经配对t检验 ,前后两次血肿区平均血流量差异有显著意义 ,P =0 0 14 ;前后两次水肿区的平均血流量略有差异 ,P =0 0 5 5 ;复查时靠近血肿区的水肿带其平均血流量较第一次检查时的水肿区的血流量有明显下降 ,P =0 0 0 4。 (3)前后两次水肿区与镜像区差异的百分比相比差异有显著意义 ,P =0 0 38;但前后两次镜像区血流量比较差异无显著意义。Objective To study the change of regional cerebral blood flow (rCBF) around hematoma in acute intracerebral hemorrhage. Methods Xenon-CT was performed on 5 patients of basal ganglia hemorrhage with the hematoma volume less than 30 ml,3 males and 2 females,aged 56.8±5.6. within 36 hours of the onset and 13 days after to measure the rCBF was measured by 27 pixel rings respectively in the core of hematoma,edema region around the hematoma and compared with rCBF in the uninvolved hemisphere. Results (1) all the 5 patients had a history of hypertension,the mean intracerebral hemorrhage volume was 13 ml ±7 ml(6.4 ～23.7 ml). The first examination was conducted 23 h±6 h(19～34 h)after the onset and the second examination was conducted 13.0 d±0.7 d(12～14 d)after the onset. (2) Within 36 hours of the onset,the mean rCBF in the core of hematoma was 15 ml· 100 g -1 · min -1 ±8 ml·100 g -1 ·min -1 ,and the mean rCBF in edema region around the hematoma was 30 ml·100 g -1 ·min -1 ±8 ml·100 g -1 ·min -1 . Thirteen days after the onset the mean rCBF in the core of hematoma was 9 ml·100 g -1 ·min -1 ±4 ml·100 g -1 ·min -1 ,significantly reduced in comparison with that measured in the first examination ( P =0.014),and the mean rCBF in the edema region around the hematoma was 23 ml·100 g -1 ·min -1 ±13 ml·100 g -1 ·min -1 ,reduced in comparison with those measured in the first examination too,however,not significantly ( P =0.055). The rCBF reduction was more significant in the edema region adjacent to the hematoma ( P =0.004),but not in the distant edema region. During the first examination the rCBF in the edema region around the hematoma was lower than the enantiomorph rCBF by 20.9%. Thirteen days after,the rCBF in the edema region around the hematoma was lower than the enantiomorph rCBF by 46.3%,significantly greater than the reduction during the first examination ( P =0.324). There was no difference between the values of enantiomorph rCBF during the

关 键 词：急性脑出血 颅内血肿 脑血流量 氙-CT 脑水肿 神经功能 

分 类 号：R743.3[医药卫生—神经病学与精神病学]