螺旋CT在高血压脑出血术后继发性脑梗死诊断及疗效观察中的价值

摘要

目的：探讨螺旋CT在高血压脑出血术后早期脑缺血/脑梗死诊断及疗效观察中的价值。方法回顾分析我院2008—2014年间收治的25例高血压脑出血术后脑梗死病例影像资料。结果25例脑出血中基底节区15例，皮层区9例，脑室内1例，血肿破入脑室5例。术后出现脑梗死共72处（按脑叶统计），其中额叶12处（17%）、颞叶12处（17%）、顶叶11处（15%）、枕叶21处（29%）、小脑3处（4%）、脑干5处（7%）、基底节区8处（11%）。随诊观察治疗效果，经治疗除了6例病例死亡，其余病例经8～40 d随诊复查，10例脑梗死区密度恢复正常，4例病情好转转院治疗，5例脑梗死区出现脑软化灶。25例患者进行随访，按照目前常用的日常生活能力分级（GOS评分）：GOS评分Ⅰ级3例（12%）；GOS评分Ⅱ级8例（32%）；GOS评分Ⅲ级5（20%），GOS评分Ⅳ级2例（8%），GOS评分Ⅴ级1例（4%）；死亡6例（24%）。结论螺旋CT扫描速度快，检查时间短，对早期发现高血压脑出血术后继发脑梗死病变、及时治疗以提高患者的生存率，降低病残率以及估计其预后有重要的意义。%Objective To study the value of spiral CT in diagnose and curative effect of cerebral ischemia/infarction following surgery for hypertensive cerebral hemorrhage (HCH). Methods Retrospective analysis the CT image data 25 cases with cerebral infarction following the surgery for HCH, who were treated in our department from, 2008 to 2014. Results In 25 cases of cerebral infarction following surgery for hypertensive cerebral Hemorrhage. There were 15 cases of basis festival area cerebral hemorrhage, 9 cases of cortical hemorrhage, 1 cases of in-traventricular hemorrhage, 5 cases of hematoma broken into ventricles. Postoperative cerebral infarction were 72 points (according to the statistics), the frontal lobe were 12 points(17%), temporal lobe were 12 points(17%), parietal lobe were 11(15%), occipital lobe were 21(29%), cerebellum were 3(4%), brainstem were 5(7%), basis festival area were 8(11%). Follow-up observation of the treatment effect, after treatment except 6 cases of death, 10 patients cerebral infarction area density returned to normal, 4 patients were illness improves and medical discharge, 5 patients appears encephalomalacia in cerebral infarction area. In 25 cases of cerebral infarction in patients with hypertensive cerebral hemorrhage were followed up , according to the current common daily life ability grade (GOS score): 3 belonged in grade Ⅰ(12%); 8 in grade Ⅱ(32%); 5 in grade Ⅲ(20%), 2 in grade Ⅳ(8%). 1 in grade Ⅴ(4%); 6 in death(24%). Conclusion The spiral CT scanning speed is fast, the inspection time is short. It is important significance in early detection and timely treatment cerebral infarction following surgery for Hypertensive Cerebral Hemorrhage, to increase the survival rate of patients, reduce morbidity and estimate its prognosis.