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目的 动态观察老年及老年前期高血压脑出血患者局部脑血流量 (rCBF)临床变化及其相关因素。方法 老年及老年前期患者分别于发病 3d内、10～ 15d、2 0～ 2 5d行SPECT和临床评分检查。静脉注射99Tcm 双半胱乙酯 (ECD) 740～ 92 5MBq后 1h显像。视觉分析按常规读片法 ;半定量分析采用感兴趣区 (ROI)技术。图像处理和临床评分采用盲法分析。结果 ①发病时缺血灶体积和数量明显大于CT的改变 (P <0 .0 0 1) ,且临床表现随缺血改善而好转 ;②老年组脑缺血性改变和临床状况在发病 3d内与老年前期组差异无显著性 (P >0 .0 5 ) ,但在 10～ 15d和 2 0～ 2 5d时差异有显著性 (P <0 .0 5～ 0 .0 1) ;③伴有糖尿病、高脂血症患者的脑缺血和临床状况的严重程度更明显 (P <0 0 5～ 0 .0 1)。结论 动态SPECT对老年人高血压脑出血后rCBF变化规律的研究和临床治疗及预后估计都有重要价值。
Objective To observe the clinical changes and related factors of regional cerebral blood flow (rCBF) in senile and elderly patients with hypertensive cerebral hemorrhage. Methods The elderly and pre-senile patients were examined by SPECT and clinical score within 3 days, 10 to 15 days and 20 to 25 days respectively. Intravenous injection of 99Tcm double-ethyl (ECD) 740 ~ 92 5MBq 1h imaging. Visual analysis by conventional reading method; semi-quantitative analysis using the region of interest (ROI) technology. Blind analysis of image processing and clinical scores. Results ① The volume and number of ischemic lesions on onset were significantly higher than those on CT (P <0.01), and the clinical manifestations improved with the improvement of ischemia; ② The ischemic changes and clinical status in the elderly group were within 3 days (P <0.05), but there was a significant difference between 10 ~ 15d and 20 ~ 25d (P <0.05 ~ 0.01) The severity of cerebral ischemia and clinical conditions in diabetic and hyperlipidemic patients was more obvious (P <0.05-0.01). Conclusions Dynamic SPECT is of great value in the study of rCBF changes and clinical treatment and prognosis of elderly patients with hypertensive intracerebral hemorrhage.