应用内囊局部脑血流量规范化评估老年少量基底核出血手术指征的临床研究

目的评价以血肿周围内囊局部脑血流量（rCBF）为标准评估少量（15~30 mL）老年高血压性基底核出血是否具有手术指征中的应用价值。方法回顾性分析邢台市第三医院2019年5月—2022年5月收治的183例老年少量基底核出血患者的临床资料，以入院时的计算机断层扫描灌注（CTP）检查所测得的血肿周围内囊rCBF数值为标准，分为轻度灌注不足组［rCBF≥15 mL/(100 g·min)］和重度灌注不足组［rCBF＜15 mL/(100 g·min)］，在两组中再根据患者是否手术分为手术亚组和保守亚组。对比两组中手术与保守两亚组间患者治疗效果的差异，以及术前术后内囊rCBF差异，评价rCBF 在决策老年少量基底核出血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比较，治疗有效、预后良好、术后内囊rCBF数值等差异无统计学意义(P＞0.05) 。重度灌注不足组手术亚组与保守亚组比较，治疗有效、预后良好、术后内囊rCBF数值等差异有统计学意义(P<0.05)。结论在老年少量基底核出血患者中，内囊轻度灌注不足者，无手术指征。内囊重度灌注不足者，手术可改善预后。内囊rCBF可作为评估老年少量高血压性基底核出血手术指征的标准。

Objective To evaluate the application value of regional cerebral blood flow(rCBF) in evaluating whether a small amount(15-30 mL) of hypertensive basal ganglia hemorrhage in the elderly has surgical indications. Methods The clinical data of 183 elderly patients with minor basal ganglia hemorrhage admitted to Xingtai Third Hospital from May 2019 to May 2022 were analyzed retrospectively. Based on the rCBF value measured by computer tomography perfusion(CTP) at the time of admission, they were divided into the mild insufficient perfusion group［rCBF≥15 mL/(100 g·min)］ and the severe insufficient perfusion group［rCBF<15 mL/(100 g·min)］. In the two groups, according to whether the patients were operated or not, they were divided into the operation subgroup and the conservative subgroup. The difference of treatment effect between the two groups and the difference of rCBF in the internal capsule area before and after operation were compared. The application value of rCBF in deciding the surgical indication of elderly patients with small basal ganglia cerebral hemorrhage was evaluated. Results Compared with the conservative subgroup, the operative subgroup in the mild hypoperfusion group had no significant difference in treatment effectiveness, good prognosis and postoperative rCBF in the internal capsule area(P>0.05). Compared with the conservative subgroup, the operative subgroup in the severe hypoperfusion group had significant difference in treatment effectiveness, good prognosis and postoperative rCBF in the internal capsule area(P<0.05). Conclusions In the elderly patients with a small amount of basal ganglia cerebral hemorrhage, there is no indication for operation in the patients with mild hypoperfusion. For patients with severe hypoperfusion, surgery can improve the prognosis. The rCBF in the internal capsule area can be used as a standard for evaluation of the surgical indications of small amount hypertensive basal ganglia hemorrhage in the elderly.