| 蒋邦治.CT灌注对介入治疗病人脑血流动力学及预后的临床价值[J].安徽医药,2025,29(6):1241-1246. |
| CT灌注对介入治疗病人脑血流动力学及预后的临床价值 |
| Clinical value of CTP in cerebral hemodynamics and prognosis of patients undergoing interventional therapy |
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| DOI：10.3969/j.issn.1009-6469.2025.06.037 |
| 中文关键词: 动脉闭塞性疾病 脑血管障碍 CT灌注 介入治疗 血管狭窄 血流动力学 预后 |
| 英文关键词: Arterial occlusive diseases Cerebrovascular disorders CT perfusion Interventional therapy Vascular stenosis Hemodynamics Prognosis |
| 基金项目: |
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| 中文摘要: |
| 目的探讨 CT灌注( CTP)对颅内大动脉闭塞或重度狭窄病人介入治疗前脑血流动力学的评估价值，并分析 CTP对病人预后的影响。方法回顾性选取 2020年 6月至 2023年 5月广西壮族自治区南溪山医院 163例接受介入治疗的颅内大动脉闭塞或重度狭窄病人。根据病人介入治疗术前是否行头颅 CTP分为 CTP组 83例和对照组 80例。记录 CTP组病人术前的相对脑血流量( rCBF)、相对脑血容量( rCBV)、相对达峰时间( rTTP)、相对平均通过时间( rMTT)。比较重度狭窄与完全闭塞病人介入治疗术前的头颅 CTP指标。比较 CTP组与对照组术后 3个月的改良 Rankin量表( mRS)评分。比较术前及术后 3个月的美国国立卫生研究院卒中量表( NIHSS)评分。分析术前 CTP指标与术前及术后 3个月的 NIHSS评分的相关性。比较 CTP组与对照组介入治疗术后的出血率。结果 CTP组病人术前头颅 CTP表现为狭窄侧 CBF较对侧明显降低， CBV轻微降低， TTP和 MTT延长。重度狭窄病人术前 rCBF高于完全闭塞病人， rTTP、rMTT低于完全闭塞病人( P<0.05)。CTP组与对照组的预后良好率分别为 90.36%(75/83)和 88.75%(71/80)，差异无统计学意义( P>0.05)。术后 3个月， CTP组与对照组的 NIHSS评分均低于术前(P<0.05)，但组间的 NIHSS评分比较，差异无统计学意义( P>0.05)。术前 rCBF与术前 NIHSS评分呈负相关( r=.0.46，P<0.05)rTTP、rMTT与术前 NIHSS评分呈正相关( r=0.55、0.51，均 P<0.05)rCBV与术前 NIHSS评分无相关性( P>0.05)。术前 rCBF、，rCBV、rTTP、rMTT与术后 3个月 NIHSS评分无相关性(P>0.05)。 CTP组，病人的出血率为 1.20%(1/83)，低于对照组的 10.00%(8/ |
| 英文摘要: |
| Objective To explore the evaluation value of CT perfusion (CTP) on cerebral hemodynamics in patients with intracraniallarge artery occlusion or severe stenosis before interventional treatment, and to analyze the impact of CTP on patient prognosis.Meth. ods A retrospective study was conducted on 163 patients with intracranial large artery occlusion or severe stenosis who received inter-ventional treatment at Nanxishan Hospital of Guangxi Zhuang Autonomous Region from June 2020 to May 2023. According to whetherthe patients underwent cranial CTP before interventional treatment, they were assigned into a CTP group (n=83) and a control group (n= 80). We recorded the preoperative relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), relative time to peak(rTTP), and relative mean transit time (rMTT) of the CTP group, compared the preoperative cranial CTP indicators between patientswith severe stenosis and those with complete occlusion. Comparisons were of the modified Rankin scale (mRS) scores between the CTPgroup and the control group at 3 months after surgery, and of the National Institutes of Health Stroke Scale (NIHSS) scores before sur-gery and 3 months after surgery. The correlations between preoperative CTP indicators and preoperative and 3-month postoperative NI-HSS scores were analyzed respectively, and the postperative bleeding rates were compared between the CTP group and the controlgroup.Results Preoperative cranial CTP in the CTP group showed a significant decrease in CBF on the narrowed side compared to thecontralateral side, a slight decrease in CBV, and prolonged TTP and MTT. The preoperative rCBF of patients with severe stenosis washigher than that of patients with complete occlusion, while rTTP and rMTT were lower than those of patients with complete occlusion (P <0.05). The good prognosis rates of the CTP group and the control group were 90.36% (75/83) and 88.75% (71/80), respectively, withno statistically significant difference (P>0.05). Three months after surgery, the NIHSS scores of the CTP group and the control group were lower than those before surgery (P<0.05). However, there was no statistically significant difference in the NIHSS scores between the groups (P>0.05). Preoperative rCBF was negatively correlated with preoperative NIHSS scores (r=.0.46, P<0.05), while rTTP and rMTT were positively correlated with preoperative NIHSS scores (r=0.55, 0.51, both P<0.05). There was no correlation between rCBV and preoperative NIHSS scores (P>0.05). There was no correlation between preoperative rCBF, rCBV, rTTP, rMTT and NIHSS scores at 3 months postoperatively (P>0.05). The bleeding rate of the CTP group was lower than that of the control group [1.20% (1/83) vs. 10.00% (8/80)] (P<0.05).Conclusions Implementing cranial CTP before interventional therapy can help evaluate cerebral hemody-namic characteristics, which is conducive to preventing postoperative intracranial hemorrhage. However, the implementation of preoper-ative cranial CTP has no influence on the prognosis. |
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