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目的研究颅脑损伤后局部脑血流(rCBF)动态变化与临床病情及预后的关系。方法选择颅脑损伤病人60例,按照GCS评分标准分成轻型损伤组45例,中型损伤组8例和重型损伤组7例,20例健康员工为对照组,对入选颅脑损伤患者在伤后2d内、1周及2周后进行单光子发射计算机断层扫描(SPECT)脑血流灌注显像与CT检查,并将结果进行对比分析。结果入院初和伤后1、2周患者SPECT检测影像学异常阳性率高于CT检测(88.3%vs46.7%,P<0.05),尤其轻型损伤组患者更为明显(84.4%vs28.9%,P<0.01),2周后头部CT显示出血及水肿大部分消退,而SPECT显示多数病人仍有脑血流灌注减低。结论rCBF的变化反应了脑损伤的程度,SPECT检查所表现的颅脑损伤后rCBF的变化对判定病情及评估预后有一定意义。
Objective To study the relationship between the dynamic changes of regional cerebral blood flow (rCBF) and clinical conditions and prognosis after craniocerebral injury. Methods Sixty patients with craniocerebral injury were selected and divided into 45 cases of light injury group, 8 cases of medium injury group and 7 cases of severe injury group according to the GCS score standard. 20 healthy workers were selected as control group. One week and two weeks later, single photon emission computed tomography (SPECT) cerebral perfusion imaging and CT examination were performed, and the results were compared. Results The positive rate of SPECT imaging at the first and second week after admission was significantly higher than that of CT (88.3% vs 46.7%, P <0.05), especially in the patients with mild injury (84.4% vs 28.9% , P <0.01). After 2 weeks, the head CT showed hemorrhage and edema mostly regressed, while SPECT showed that most patients still had decreased cerebral perfusion. Conclusion The changes of rCBF reflect the extent of brain injury. The changes of rCBF after craniocerebral injury manifested by SPECT are of certain significance for judging the disease and evaluating the prognosis.