内囊区局部脑血流量在少量基底节出血手术指征评估中的临床价值

Clinical value of regional cerebral blood flow in the internal capsule area in evaluating the surgical indication for minor basal ganglia hemorrhage

摘要:

目的 为少量（15~30 mL）高血压性基底节出血（HBGH）手术指征的评估提供一种基于客观指标的方法。方法 分析198例少量基底节脑出血患者的病历资料，以入院时所测得的血肿同侧内囊区局部脑血流量（rCBF）数值为标准分为轻度灌注不足组[rCBF≥15 mL/100(g·min)]103例和重度灌注不足组[rCBF＜15 mL/100(g?min)]95例，在两组中再根据患者是否手术，分别分为手术亚组和保守亚组。对比两组中手术与保守2亚组间患者治疗效果的差异，以及术后内囊区rCBF差异，评价rCBF在评估少量HBGH患者手术指征中的应用价值。结果 轻度灌注不足组手术亚组与保守亚组的治疗有效、预后良好、术后内囊区rCBF数值等比较，差异无统计学意义(P＞0.05)，重度灌注不足组手术亚组与保守亚组的治疗有效、预后良好、术后内囊区rCBF数值等比较，差异有统计学意义(P<0.05)。结论 内囊区rCBF可作为评估少量HBGH手术指征的客观指标，内囊区轻度灌注不足者，手术不能明显改善脑灌注和预后，故无手术指征。重度灌注不足者，手术可明显改善脑灌注和预后，故有手术指征。

Abstract:

Objective To provide a method based on objective indicators for evaluating the surgical indication for minor （15-30 mL） hypertensive basal ganglia hemorrhage （HBGH）.Methods A retrospective analysis was performed for the case data of 198 patients with minor HBGH， and according to the value of regional cerebral blood flow （rCBF） in the ipsilateral internal capsule of hematoma， the patients were divided into mild hypoperfusion group ［rCBF ≥15 mL/（100g·min）］ with 103 patients and severe hypoperfusion group ［rCBF <15 mL/（100g·min）］ with 95 patients. According to whether the patient underwent operation， each group was further divided into surgical treatment subgroup and conservative treatment subgroup. The two subgroups were compared in terms of treatment outcome and rCBF in the internal capsule after surgery， and the application value of rCBF in evaluating the surgical indications for patients with minor HBGH was analyzed.Results In the mild hypoperfusion group， there were no significant differences between the conservative treatment subgroup and the surgical treatment subgroup in treatment response， favorable prognosis， and postoperative rCBF value in the internal capsule （P >0.05）， while in the severe hypoperfusion group， there were significant differences in these indicators between the two subgroups （P <0.05）.Conclusions The rCBF value in the internal capsule can be used as an objective indicator for evaluating the surgical indications for minor HBGH. For patients with mild hypoperfusion in the internal capsule， surgery cannot significantly improve cerebral perfusion and prognosis， and therefore， there is no surgical indication. For patients with severe hypoperfusion， surgery can significantly improve cerebral perfusion and prognosis， so there is surgical indication.