Davis S M, Chua M G, Lichtenstein M, Rossiter S C, Binns D, Hopper J L
University Department of Medicine, Royal Melbourne Hospital, Victoria, Australia.
Stroke. 1993 Nov;24(11):1691-6. doi: 10.1161/01.str.24.11.1691.
The value of acute cerebral blood flow measurements in stroke prognosis is controversial. No previous study has determined whether acute perfusion deficits independently add to a validated clinical prognostic score. We aimed to compare the value of acute hypoperfusion deficits with a quantitative clinical score in stroke prognosis and to correlate the changes in perfusion with brain recovery.
Volumetric analysis of regional hypoperfusion was performed in 38 patients with middle cerebral infarction within 72 hours of onset by use of single photon emission computed tomography and 99mTc hexamethylpropylene amine oxime. Stroke severity was assessed by the Canadian Neurological Score and Barthel Index. Allen's prognostic score was determined acutely in all patients. Clinical outcome was evaluated in 36 of 38 patients, of whom 18 had repeat blood flow studies.
Acute hypoperfusion correlated with both the outcome Barthel Index (P < .001, r = -.61) and Canadian Neurological Score (P < .001, r = -.64). Allen's score correlated better with both the outcome Barthel Index (P < .001, r = .80) and Canadian Neurological Score (P < .001, r = .81). Acute hypoperfusion deficits, after allowing for Allen's score, independently predicted neurological but not functional outcome. Despite overall neurological improvement, mean hypoperfusion increased on the repeat blood flow studies (P < .05).
Volumetric analysis of acute regional hypoperfusion within 72 hours of onset predicts stroke outcome after 3 months, but Allen's score is a better prognostic method. Neurological recovery is not associated with chronic infarct reperfusion.
急性脑血流量测量在卒中预后中的价值存在争议。既往尚无研究确定急性灌注缺损是否能独立补充到一个经过验证的临床预后评分中。我们旨在比较急性灌注不足缺损与定量临床评分在卒中预后中的价值，并将灌注变化与脑恢复情况相关联。
在38例大脑中动脉梗死发病72小时内的患者中，通过单光子发射计算机断层扫描和99m锝六甲基丙烯胺肟进行局部灌注不足的容积分析。采用加拿大神经功能评分和巴氏指数评估卒中严重程度。所有患者均急性测定艾伦预后评分。对38例患者中的36例进行临床结局评估，其中18例进行了重复血流研究。
急性灌注不足与结局巴氏指数（P <.001，r = -0.61）和加拿大神经功能评分（P <.001，r = -0.64）均相关。艾伦评分与结局巴氏指数（P <.001，r = 0.80）和加拿大神经功能评分（P <.001，r = 0.81）的相关性更好。在考虑艾伦评分后，急性灌注不足缺损可独立预测神经功能结局，但不能预测功能结局。尽管总体神经功能有所改善，但重复血流研究显示平均灌注不足增加（P <.05）。
发病72小时内急性局部灌注不足的容积分析可预测3个月后的卒中结局，但艾伦评分是更好的预后评估方法。神经功能恢复与慢性梗死再灌注无关。
