| Objective: The changes of local cerebral blood flow in patients with severe craniocerebral injury were analyzed after decompression of craniocerebral craniocerebral injury.To evaluate the relationship between local cerebral hemodynamic parameters and Glasgow coma score(GCS)and Glasgow prognosis score(GOS),and to further evaluate whether the hemodynamic parameters rCBF,rMTT and r CBV can be used to predict the prognosis of patients.Methods:Collect 27 patients with traumatic brain injury patients after decompressive craniectomy were admitted to the department of Neurosurgery,The First Affiliated Hospital of Wannan Medical College(Yijishan Hospital)from 2019 January to November 2020.CT cerebral perfusion scan was added while dynamic CT review was performed within 1-3 days after surgery.The clinical and imaging data of the patients during hospitalization were collected.Statistical methods were used to analyze the hemodynamic parameters of patients after decompression,and to evaluate the relationship between hemodynamic parameters and Glasgow coma score(GCS)and Glasgow prognosis score(GOS),as well as whether these hemodynamic parameters rCBF,rMTT and r CBV could be used to predict the prognosis of patients.Results: 1)All patients undergoing perfusion CT examinations were well tolerated and had no adverse reactions,such as allergic reactions to contrast agents,extravasation of contrast agents,or nephrotoxicity.2)The average rCBF,r CBV,and rMTT of the basal ganglia on the surgical side were 42.9389±6.24051,3.2319±0.60021,4.4996±1.06469,respectively.The average rCBF,r CBV,and rMTT in the contralateral basal ganglia were 45.7937±5.43831,3.3159±0.50751,4.07±0.91389.Comparing the cerebral hemodynamic parameters of the basal ganglia on the surgical side and the contralateral side,it was found that rCBF P<0.05,rMTT P<0.05 were statistically significant,and r CBV P>0.05,which was not statistically significant.3)The relationship between GCS classification and hemodynamic parameters rCBF,rMTT,r CBV.It was found that the rCBF of the basal ganglia on the surgical side and the contralateral basal ganglia increased with the increase of the GCS grade,and the rMTT decreased with the increase of the GCS grade.There was no statistical significance between them.The r CBV did not increase with the neurological function grade.3.1)The average rCBF of the basal ganglia on the surgical side increased with the increase of GCS grade,but there was no significant difference in rCBF among patients with GCS3-4,5-6,and 7-8(P>0.05),which were 40.9117± 7.88653,41.0133±5.68388,45.3967±5.33076 ml/100g/min.3.2)The average rCBF of the contralateral basal ganglia increased with the increase of GCS grade,but there was no significant difference in rCBF among patients with GCS3-4,5-6,and 7-8(P>0.05),respectively43.265± 5.35465,44.64±5.12444,47.9233±5.31504 ml/100g/min.3.3)The average rMTT of the basal ganglia on the surgical side decreased with the increase of GCS grade,but there was no significant difference in rMTT values ??among patients with GCS3-4,5-6 and 7-8 grades(P>0.05),respectively 4.9083± 1.05276,4.4±1.16486 and4.37±1.03497 s.3.4)The average rMTT of the contralateral basal ganglia decreased with the increase of GCS grade,but there was no significant difference in rMTT values??among patients with GCS3-4,5-6 and 7-8 grades(P>0.05),respectively 4.3833±1.29958,4.11±0.80198 and 3.8833±0.80361 s.3.5)The average r CBV of the basal ganglia on the surgical side does not increase with neurological function classification.The values ??of GCS3-4,5-6 and 7-8 patients were 3.0217±0.68183,3.2489±0.54796,3.3242±0.62303ml/100 g,respectively,and there was no significant difference between them(P>0.05).The average r CBV of the basal ganglia on the surgical side did not increase with neurological function classification.The values??of GCS3-4,5-6 and 7-8 patients were 3.0217±0.68183,3.2489±0.54796,3.3242±0.62303ml/100 g,respectively,and there was no significant difference between them(P>0.05).3.6)The average r CBV of the contralateral basal ganglia does not increase with neurological function classification.The values ??of GCS3-4,5-6,and7-8 patients were 3.2533±0.72193,3.5622±0.45365,3.1625±0.38051ml/100 g,respectively,and the difference was not significant(P>0.05).4)The relationship between hemodynamic parameters rCBF,rMTT,r CBV and prognosis.4.1)The average rCBF(46.895±7.52357ml/100g/min)in the basal ganglia of the good prognosis group was higher than the average rCBF(40.6118±3.98852ml/100g/min)in the basal ganglia of the poor prognosis group,and the difference was significant(P<0.05).The average rCBF of the corresponding areas in the good prognosis group and the poor prognosis group were 49.248±4.87092,43.7618±4.78221 ml/100g/min,respectively,and there was no statistical significance between the two(P<0.05).4.2)The prognosis results become worse with the prolongation of rMTT.The average rMTT(3.728±0.41217s)of the basal ganglia on the operation side of the good prognosis group is smaller than the average rMTT of the basal ganglia on the operation side of the poor prognosis group(4.9535±1.07492s),and the difference is significant(P<0.05).The average rMTT of the corresponding areas on the contralateral side of the good prognosis group and the poor prognosis group were 3.534±0.39741 s and 4.3853±0.99155 s,respectively,and the difference was not significant(P>0.05)4.3)The good prognosis group and the poor prognosis group of the surgical side and the contralateral The average r CBV was not statistically significant,(P>0.05).The average r CBV of the surgical basal ganglia in the good prognosis group(3.251±0.53863ml/100g)VS the average r CBV of the surgical basal ganglia in the poor prognosis group(3.2206±0.64949ml/100g),the difference was not significant(P>0.05).The average r CBV of the contralateral basal ganglia in the good prognosis group(3.363±0.43295ml/100g)VS the average r CBV of the contralateral basal ganglia in the poor prognosis group(3.2882±0.5576ml/100g),the difference was not significant(P>0.05)Conclusion: There were no significant differences in rCBF,rMTT and r CBV among patients with severe craniocerebral injury with different GCS grades(GCS3-4,GCS5-6and GCS7-8).Patients with good prognosis had higher rCBF and lower RMTT,and patients with poor prognosis had lower rCBF and higher rMTT.Discriminant analysis of these parameters could predict the prognosis of patients with a probability of 70.6%.Early reduction of rCBF and prolongation of rMTT may affect the clinical outcome of TBI.These parameters are helpful to assess the severity of cerebral circulation disorders and predict the prognosis of patients with craniocerebral injury.Further studies are needed to determine the threshold range of parameters,and the value of incorporating rCBF and rMTT studies into clinical decision-making of severe craniocerebral injury to guide further clinical treatment of patients. |
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