CT血管成像和CT灌注点征的联合应用在选择中等量脑出血超早期手术方式中的价值

Value of the spot sign on computed tomography angiography and computed tomography perfusion in selecting ultra-early surgical procedure for patients with moderate cerebral hemorrhage

摘要:

目的 探讨联合应用CT血管成像（CTA）、CT灌注（CTP）点征在基底节中等量脑出血超早期抽吸术或开颅手术的手术方式选择中的应用价值。方法 选择中等量基底节脑出血（出血量30~60ml）且家属同意超早期手术治疗221例，根据入院后患者是否同意行颅脑CTA及CTP检查，分为研究组（同意检查者）105例，对照组（不同意检查者）116例，研究组CTA或CTP点征阳性者，入开颅手术亚组32例，CTA和CTP点征阴性者入抽吸亚组73例。对照组根据患者家属知情同意后选择的手术方式，分为开颅亚组39例，抽吸亚组77例。对比研究组与对照组患者治疗效果的差异，评估联合应用CTA、CTP点征在基底节中等量脑出血超早期手术方式选择中的应用价值。结果 研究组有效率、术后血肿增大率、病死率、颅内感染率分别为77.1%、3.8%、3.8%、2.9%，对照组分别为52.6%、18.1%、15.6%、12.1%，2组比较差异有统计学意义。（P<0.05）。结论 联合应用CTA、CTP点征选择基底节中等量脑出血手术方式，可明显改善患者预后。

Abstract:

Objective To investigate the value of the spot sign on computed tomography angiography (CTA) and computed tomography perfusion (CTP) in selecting the surgical procedure of early-stage aspiration or craniotomy for patients with moderate basal ganglia hemorrhage.Methods A total of 221 patients with moderate basal ganglia hemorrhage (a bleeding volume of 30~60 ml) whose family members agreed to ultra-early surgical procedure were enrolled, and according to whether they were willing to undergo cranial CTA and CTP after admission, they were divided into experimental group (with 105 patients willing to undergo examination) and control group (with 116 patients unwilling to undergo examination). According to the positive or negative result of the spot sign on CTA or CTP for the patients in the experimental group, 32 patients with a positive result were treated with craniotomy and 73 with a negative result were treated with aspiration. According to the surgical procedure selected by family members after informed consent was given, the control group was further divided into craniotomy subgroup with 39 patients and aspiration subgroup with 77 patients. Clinical outcome was compared between the experimental group and the control group to evaluate the value of the spot sign on CTA and CTP in selecting ultra-early surgical procedure for moderate basal ganglia hemorrhage.Results There were significant differences between the experimental group and the control group in response rate (77.1% vs 52.6%, P<0.05), rate of postoperative hematoma enlargement (3.8% vs 18.1%, P<0.05), mortality rate (3.8% vs 15.6%, P<0.05), and intracranial infection rate (2.9% vs 12.1%, P<0.05).Conclusions Surgical procedure for moderate basal ganglia hemorrhage selected based on a combination of the spot sign on CTA and CTP can significantly improve patients' prognosis.