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目的探讨CT灌注(CTP)成像在高血压性基底节区小量(<30 ml)出血治疗方案评估中的价值。方法 2011年4月至2016年5月收治高血压性基底节区小量出血254例,根据入院时脑CTP成像检查结果中血肿周围局部脑血流量(rCBF)分为轻度低灌注组[rCBF≥15 ml/(100 g·min);144例]和重度低灌注组[rCBF<15 ml/(100 g·min);110例];两组又根据治疗方法分为手术亚组和非手术亚组。发病28 d采用改良Rankin量表(mRS)评分评估疗效,0~3分为有效,4~5分为无效。结果轻度低灌注组:手术亚组入院后7 d rCBF与入院时无明显差异(P>0.05);非手术亚组入院后7 d rCBF与入院时也无明显差异(P>0.05)。重度低灌注组:手术亚组入院后7 d rCBF较入院时明显增高(P<0.05);非手术亚组入院后7 d rCBF与入院时无明显差异(P>0.05)。轻度低灌注组:手术亚组有效率(79.7%,59/74)与非手术亚组(77.1%,54/70)无统计学差异(P>0.05)。重度低灌注组:手术亚组有效率(64.9%,37/57)明显高于非手术亚组(41.5%,22/53;P<0.05)。结论 CTP成像可提供脑出血周围脑组织血流客观数据,为小量基底节区出血手术指征的把握有较好的指导意义。
Objective To investigate the value of CT perfusion imaging (CTP) imaging in the evaluation of small amount (<30 ml) hemorrhage in hypertensive basal ganglia. Methods From April 2011 to May 2016, 254 patients with small hemorrhage of hypertensive basal ganglia were enrolled. According to the results of cerebral CTP imaging on admission, the regional cerebral blood flow (rCBF) around the hematoma was divided into mild hypoperfusion group [rCBF 144 cases) and severe hypoperfusion group [rCBF <15 ml / (100 g · min); 110 cases). The two groups were divided into operation subgroup and non-operation Subgroup. On the 28th day, the modified Rankin Scale (mRS) was used to evaluate the curative effect. 0 ~ 3 were effective and 4 ~ 5 were not effective. Results In mild hypoperfusion group, there was no significant difference in rCBF between admission and 7 days after operation (P> 0.05). No significant difference was found between rCBF and admission at 7 days after operation in non-operation subgroup (P> 0.05). Severe hypoperfusion group: The rCBF in the operation subgroup at 7 days after admission was significantly higher than that at admission (P <0.05). There was no significant difference in rCBF at admission between the non-operation subgroup and admission (P> 0.05). In mild hypoperfusion group, there was no significant difference between operative subgroups (79.7%, 59/74) and nonsurgical subgroups (77.1%, 54/70) (P> 0.05). In the severe hypoperfusion group, the operative subgroup efficiency (64.9%, 37/57) was significantly higher than that in the nonoperative subgroup (41.5%, 22/53; P <0.05). Conclusion CTP imaging can provide objective data of cerebral blood flow around cerebral hemorrhage. It is a good guide for the indication of small basal ganglia hemorrhage.