摘要：

目的 探讨血肿穿刺置管引流术（简称引流术）对自发性幕上出血患者血肿周围组织血流动力学的影响。方法 30例自发性幕上出血患者于引流术后行 CT灌注成像，以血肿侧和对侧镜像区血肿中央区、血肿周围水肿区、血肿周围水肿区外侧（距离水肿边缘 1 cm）和远隔皮质区作为兴趣区，测量各区域脑血流量（CBF）、脑血容量（CBV）、平均通过时间（MTT）和达峰时间（TTP）。结果 （1）脑出血后血肿周围组织存在不同程度低灌注。与对侧镜像区相比较，血肿侧血肿中央区 CBF 值（P = 0.000）和CBV 值（P = 0.000）降低、MTT 值延长（P = 0.000），但未见峰值；血肿周围水肿区 CBF 值（P = 0.000）和 CBV值（P = 0.000）降低、MTT 值延长（P = 0.000）；血肿周围水肿区外侧 CBF 值（P = 0.000）和 CBV 值（P =0.000）降低；而血肿侧与对侧镜像区远隔皮质区 CBF、CBV、MTT 和 TTP 值差异均无统计学意义（P >0.05）。（2）脑出血后自血肿中央区至远隔皮质区灌注参数呈阶梯样改变。血肿侧自血肿中央区至远隔皮质区 CBF 值和 CBV 值逐渐增大（均 P < 0.05）、MTT 值逐渐减少（均 P < 0.05），而 TTP 值差异无统计学意义（P > 0.05）；对侧镜像区血肿中央区、血肿周围水肿区、血肿周围水肿区外侧与远隔皮质区 CBF、CBV、MTT和TTP值差异均无统计学意义（P > 0.05）。（3）引流术后血肿周围水肿区 CBF值（P = 0.000）和 CBV 值（P = 0.000）高于术前。结论 血肿穿刺置管引流术可以明显提高血肿周围组织血流灌注。

关键词: 脑出血, 引流术, 血流动力学, 体层摄影术, X 线计算机

Abstract:

Objective To investigate the effect of hematoma puncture and catheter drainage on perihematomal cerebral hemodynamics in patients with spontaneous supratentorial intracerebral hemorrhage (ICH). Methods A total of 30 patients with spontaneous supratentorial ICH underwent hematoma puncture and catheter drainage. CT perfusion imaging (CTP) was used to determine regions of interest (ROIs) in the central hematoma, perihematomal edema (PHE), peripheral PHE (1 cm from the margin of PHE) and remote cortex in both hematoma side and enantiomorphic contralateral side. Cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT) and time to peak (TTP) of ROIs were measured. Results 1) Different degrees of hypoperfusion existed in perihemtomal brain tissue after ICH: compared with enantiomorphic contralateral side, CBF (P = 0.000) and CBV (P = 0.000) were significantly decreased, MTT was prolonged (P = 0.000), while peak was not reached in the central hematoma; CBF (P = 0.000) and CBV (P = 0.000) were significantly decreased, while MTT was prolonged in PHE (P = 0.000);CBF (P = 0.000) and CBV (P = 0.000) were significantly decreased in peripheral PHE of hematoma side. There was no significant difference on CBF, CBV, MTT and TTP in remote cortex between hematoma side and enantiomorphic contralateral side (P > 0.05, for all). 2) The perfusion parameters showed stepped change from central hematoma to remote cortex: CBF and CBV showed a gradual increase (P < 0.05, for all), and MTT showed a gradual decrease from central hematoma to remote cortex of hematoma side (P < 0.05, for all), while TTP showed no significant difference (P > 0.05). There was no significant difference on CBF, CBV, MTT and TTP among central hematoma, PHE, peripheral PHE and remote cortex of enantiomorphic contralateral side (P > 0.05, for all). 3) CBF (P = 0.000) and CBV (P = 0.000) in PHE after operation were significantly higher than those before operation. Conclusions Hematoma puncture and catheter drainage can effectively improve the perfusion of perihematomal regions.

Key words: Cerebral hemorrhage, Drainage, Hemodynamics, Tomography, X-ray computed