摘要
目的探讨cT灌注成像（CTP）在脑室-腹腔分流术（VP）术后压力设定中的作用以及意识改变与脑灌注的关系。方法选取2013年8月-2015年3月收治的创伤性脑损伤（TBI）后脑积水行VP术后均处于植物生存状态或微小意识状态的患者30例，其中男26例，女4例；年龄（56．4±9．2）岁，病程（88．7±38．0）d。调压前及调压后2周分别行意识状态评定及头颅CTP检查。根据意识评定结果将患者分为意识无好转组（17例）及意识好转组（13例），分别比较两组调压前后相对脑血流量（rCBF）、相对脑血容量（rCBV）、相对平均通过时间（rMTT）及相对峰值时间（rTTP）等变化。结果意识好转组侧脑室前角周围白质rCBF调压前为0．75±0．32，调压后为1．08±0．55（P〈0．05），侧脑室前角周围白质的rCBV、rMTT、rTTP调压前后差异均无统计学意义（P〉0．05），软化灶、额叶、颞叶、基底节、枕叶等各部位调压前后rCBF、rCBV、rMTT、TTP比较差异均无统计学意义（P〉0．05）。意识无好转组调压前后上述各指标比较差异无统计学意义（P〉0．05）。结论对于TBI后脑积水患者，CTP对VP术后的压力调整具有一定的参考价值。调压后意识的好转与侧脑室前角周围白质脑血流量增加有关。
Objective To investigate the value of CT perfusion imaging （CTP） in pressure modulation after ventriculoperitoneal shunt （VP） and determine the relationship between consciousness variation and cerebral perfusion. Methods Thirty cases in a vegetative or minimally conscious state after VP for posttraumatic hydrocephalus were included. There were 26 males and 4 females, aged （56.4 -＋ 9.2） years. Duration of disease was （88.7 _＋ 38.0）d. Consciousness evaluation and CT perfusion scan were performed before and two weeks after pressure modulation. Based on the consciousness state, the patients were allocated into consciousness unimproved （n = 17 ） and improved groups （n = 13 ）. Relative cerebral blood flow （rCBF） , relative cerebral blood volume （rCBV）, relative mean transit time （rMTF） and relative time to peak （rTTP） were evaluated before and after pressure modulation. Results In consciousness improved group rCBF in the alba around anterior horn of lateral ventricle was significantly improved after pressure modulation compared to that before pressure modulation （ 1.08 ± 0.55 vs. 0.75 ±0.32 ,P 〈0.05 ） , but rCBV, rMTT and rTTP did not differ significantly in the same region （P 〉0.05 ）. In consciousness improved group all the measures showed no significant changes in other regions such as encephalomalacia focus, forehead lobe, temporal lobe, basal ganglia and occipital lobe （P 〉 0. 05）. However, none was significantly different in consciousness unimproved group （P 〉 0. 05）. Conclusions CTP has some reference value on pressure modulation of posttraumatic hydrocephalus patients treated with VP. Consciousness improvement is related to the increased cerebral perfusion in the alba around anterior horn of lateral ventricle.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2016年第2期115-119,共5页
Chinese Journal of Trauma
基金
浙江省医药科研卫生项目（2013KYA178）
浙江省科技厅公益类项目（2013C33160）
关键词
灌注成像
脑积水
脑室-腹膜分流术
Perfusion imaging
Hydrocephalus
Ventriculoperitoneal shunt
