中文摘要：

目的利用CT血管造影（CTA）联合CT灌注成像（CTP）方法探讨蛛网膜下腔出血（SAH）所致脑血管痉挛（CVS）与迟发性脑缺血（DCI）的相关性。方法利用CTA与CTP技术分析116例SAH病人,CTP指标包括脑血流量（CBF）、脑血容量（CBV）、平均通过时间（MTT）等,在病人入院时、病情恶化时间段及入院后14 d记录CTA图像显示的脑血管痉挛程度和迟发性局灶脑缺血的发生情况,评估发生痉挛的脑血管支配区域与脑灌注图上血流灌注面积间的相关性及不同程度脑血管痉挛导致脑血流灌注和DCI发生之间的差异。结果 45例病人无脑血管痉挛,占38.8%;51例病人发生中等程度脑血管痉挛,占44.0%;20例病人发生严重脑血管痉挛,占17.2%。61.2%脑血管痉挛病人,最少的脑缺血灌注区域与痉挛严重血管的血流区域一致,无血管痉挛区域与严重脑缺血区域CBF明显不同。20例发生严重脑血管痉挛病人中14例出现迟发性局灶脑缺血;51例发生中等程度的脑血管痉挛病人中7例出现迟发性局灶脑缺血;45例无脑血管痉挛病人中4例出现迟发性局灶脑缺血。血管痉挛降低脑血流灌注,但只有66.67%病人脑血管痉挛与乏血供的灌注区域相一致,33.33%严重脑血管痉挛的病人无迟发性脑缺血。结论虽然严重脑血管痉挛能降低脑血流的灌注水平,但血管痉挛不会直接导致迟发性脑缺血。

英文摘要：

Objective To investigate the relationship between cerebral vasospasm（ CVS） and delayed cerebral ischemia（ DCI） in patients with subarachnoid hemorrhage（ SAH） using CT angiography（ CTA） and CT perfusion imaging（ CTP）. Methods One hundred and sixteen patients with SAH were selected. CTA and CTP technology were used.CTP index was including cerebral blood flow（ CBF）,cerebral blood volume（ CBV）,mean transit time（ MTT）. CTA imaging and DCI were recorded at admission of patients with CVS,the time period of deterioration and 14 days after admission.The correlation between the control area of CVS-related cerebral vascular and perfusion area in cerebral perfusion map was assessed.The difference between the brain perfusion of different degree and the occurrence of DCI was assessed. Results Forty-five patients without CVS accounted for 38. 8%. Fifty-one patients had moderate CVS,accounting for 44%. Twenty patients had severe CVS,accounting for 17.2%.In 61.2% patients with CVS,cerebral ischemia reperfusion blood flow area was consistent with the regional minimum vascular spasm,and there was difference in CBF between non-vasospasm region and severe cerebral ischemia. Of 20 patients with severe CVS,14 patients had DCI. Of 51 patients with moderate CVS,7 patients suffered from DCI. Of 45 patients without CVS,4 patients suffered from DCI. Conclusion The vascular spasm reduces cerebral blood flow perfusion,but only 2 /3 cases of cerebral vascular spasm and blood perfusion region is consistent,and almost 1 /3 of the patients with severe CVS had DCI.Therefore,although serious CVS can reduce the cerebral blood flow perfusion level,but it will not directly lead to DCI.