摘要
目的通过结合临床及影像学表现，评估多个可能相关的影响因素与血管内介入治疗后早期脑出血和对比剂外渗的关系，以及与双能CT表现结合对迟发脑出血的预测价值。方法回顾性收集2017年2月-2018年2月首都医科大学宣武医院收治的50例急性缺血性脑卒中行血管内介入治疗，且术后24h内行双能CT头颅平扫检查的患者，采集患者性别、年龄、治疗前NIHSS评分、术前静脉溶栓情况、闭塞血管位于前，后循环、卒中发作至血管再通时间、介入手术时长、血管再通情况（TICI分级）、介入手术后-双能CT检查时间间隔等临床资料，分析双能CT表现，分别比较各指标在早期无出血组、对比剂渗出组及出血组之间的差异，以及在无脑出血组及迟发脑出血组之间的差异。结果50例患者中，11例于术后24h内发生脑出血，11例于术后24h后发生。前循环血管闭塞者易发生早期脑出血（P〈0．05）；术前高NIHSS评分、术前静脉溶栓治疗及对比剂渗出者继发脑出血的风险有增高趋势，但差异无统计学意义（均P〉0．05）。其余指标在组间均亦未发现明显统计学差异。结论双能CT有助于识别急性缺血性脑卒中患者血管内介入治疗后早期脑出血及对比剂渗出的发生；而术前NIHSS评分、术前静脉溶栓及双能CT发现对比剂渗出等对术后迟发性脑出血具有一定的提示意义，应对相应患者进行重点观察。以改善预后。
Objective To evaluate the association between several factors and early intracerebral hemorrhage/iodine extravasation after endovascular intervention therapy（ET） of acute ischemic stroke, and the predictive value of these factors together with the DE-CT findings. Methods This was a retrospective study. 50 patients who underwent brain dual-energy CT（DE-CT） in 24h after endovascular intervention therapy for acute ischemic stroke. The following variables were collected： gender, age, NIHSS score at admission, previous intravenous thrombolytic therapy, site of vessel occlusion, time to recanalization, duration of ET procedure, recanalization TICI score, time to DE-CT and the follow-up CT/MRI findings. The differences of above variables were evaluated among the no early hemorrhage group, iodine extravasation and the early hemorrhage group, and between the no hemorrhage group and the delayed hemorrhage group. Results Of the 50 patients studied, 11 patients developed hemorrhage within 24h after ET, and 11 patients developed hemorrhage beyond 24h after ET. The occlusion of anterior circulation may have greater risk for development of hemorrhage, compared with the occlusion of posterior circulation（P 〈0.05）. The higher NIHSS score at admission, previous intravenous thrombolytic therapy and the finding of iodine extravasation in DE-CT tended to have higher rates of delayed hemorrhage, but there was no statistical significant difference between the two groups（P 〉0.05）. Other variables had no statistical significant difference among the groups. Conclusion DE-CT is reliable to identified the early hemorrhage and iodine extravasation. Several factors may have suggestive values to a certain degree for the delayed intracranial hemorrhage, which secondary to endovascular intervention therapy in acute ischemic stroke, such as the higher NIHSS score at admission, the previous intravenous thrombolytic therapy and the finding of iodine extravasation in DE-CT.
作者
李清
吴芳
刘佳宾
祝小莲
王臣
王艳
李倩文
杜祥颖
卢洁
LI Qing, WU Fang, LIU Jia-bin, ZHU Xiao-lian, WANG Chen, WANG Yan, LI Qian-wen, DU Xiang-ying, LU Jie.(Xuanwu Hospital Capital Medical University Beijing 100053 China)
出处
《中国急救复苏与灾害医学杂志》
2018年第5期437-441,共5页
China Journal of Emergency Resuscitation and Disaster Medicine
基金
北京市医院管理局重点医学专业发展计划（ZYLX201609）
北京市医院管理局临床医学发展专项经费资助（ZYLX201706）
首都临床特色应用研究与成果推广项目（Z161100000516087）
关键词
急性缺血性脑卒中
脑出血
血管内介入治疗
双能CT
acute ischemic stroke
intracranial hemorrhage
endovascular intervention
dual-energy CT
