摘要
目的:探讨640层螺旋CT全脑灌注成像联合CT血管造影一站式成像在颅脑术后诊断的价值。方法:选取2014年7月-2017年8月期间在本院进行治疗的颅脑术后伴并发症(脑内新发低密度灶)的患者23例,均接受640层螺旋CT全脑灌注成像联合CT血管造影一站式成像检查,分析脑内低密度灶区的灌注参数图像,并根据4D-CTA判断颅内大血管阻断或狭窄及分支缺损情况。对比不同脑内灌注患者经临床干预性处理后的预后情况,分析不同格拉斯哥昏迷评分法(GCS)评分与低灌注患者预后的关系,再结合患者检查当时的格拉斯哥昏迷评分法(GCS)进行综合分析,对患者的病情进行预判,协助临床医师在治疗的过程中早期给予干预。结果:23例患者的灌注参数图像[局部脑血流量(rCBF)、局部脑血容量(rCBV)、平均通过时间(MTT)]都存在明确的异常表现,显示脑内不同程度低灌注22例,脑内高灌注1例。低灌注病例中有7例患侧颅内大血管存在异常改变,其中左侧大脑中动脉狭窄或闭塞4例,右侧大脑中动脉狭窄1例,左侧大脑前动脉重度狭窄或闭塞1例,右侧大脑后动脉闭塞1例。脑内低灌注患者经临床针对性处理后预后良好50.00%(11/22),死亡18.18%(4/22),而脑内高灌注患者预后良好100%(1/1),死亡0,但比较差异无统计学意义(P>0.05)。GCS评分≤3分的脑内低灌注患者死亡率为100%(4/4),高于GCS评分4～8分、9～11分以及≥12分患者;GCS评分4～8分的脑内低灌注患者重度残疾80.00%(4/5),高于GCS评分≤3分与≥12分患者,差异均有统计学意义(P<0.05)。结论:CT全脑灌注一站式成像应用于颅脑术后伴并发症中具有较高的诊断价值,(脑内新发低密度灶)患者进行CT全脑灌注一站式成像检查,有助于了解颅脑术后局部脑组织血流灌注情况,并为患者预后评估以及干预措施的制定提供指导,对患者术后病情的预后判断提供帮助,对临床治疗过程中的适时
Objective:To explore the value of 640-slice spiral CT perfusion imaging combined with CT angiography one-stop imaging in postoperative diagnosis of the brain.Method:23 patients in our hospital for treatment of craniocerebral surgery with complications(new low density focal brain)were selected from July 2014 to August 2017 as the research objects,they were accepted 640 layer spiral CT cerebral perfusion imaging in combination with CT angiography one-stop imaging,the perfusion parameters of the images of low density focal brain area were analysed,according to the 4D-CTA judgment of intracranial vascular branch block or narrow and defect.The prognosis of patients with different intracerebral perfusion after clinical intervention were compared,the relationship between different Glasgow coma scale(GCS)score and prognosis of patients with low perfusion was analyzed.Result:23 cases of regional cerebral blood flow(rCBF),regional cerebral blood volume(rCBV),average(determined by MTT)were abnormal performance over time,according to the low degree of different brain perfusion 22 cases,brain perfusion in 1 case.Low perfusion cases there were 7 cases of intracranial vascular abnormalities,4 cases of left middle cerebral artery stenosis or occlusion,1 case of right middle cerebral artery stenosis,1 case on the left side of the severe stenosis or occlusion of the anterior cerebral artery,1 case of right posterior cerebral artery occlusion.Brain after clinical targeted treatment outcomes for patients with low perfusion good accounted for 50.00%(11/22),the number of deaths accounted for 18.18%(4/22),and the prognosis of patients with brain high perfusion good accounted for 100%(1/1),the number of deaths accounted for 0,there was no statistically significant difference(P>0.05).The mortality rate of patients with intracerebral hypoperfusion whose GCS score was less than or equal to 3 points was 100%(4/4),higher than those with GCS score of 4-8 points,9-11 points and 12 points or more.The number of patients with severe disability wi
出处
《中国医学创新》
CAS
2019年第7期66-72,共7页
Medical Innovation of China
基金
广东省茂名市科技项目(20150334)
