目的探讨640层CT脑灌注成像 (CTP)在急性缺血性脑卒中再灌注治疗中 的应用。方法 选择2016年1月至2018年1 月我院急诊科收治的急性缺血性脑卒中患 者52例，其发病时间在4.5h之内且均进行 静脉重组组织型纤溶酶原激活剂(rt-PA) 溶栓治疗，治疗前行CT平扫和CTP，根据 患者治疗后是否发生出血性转化(HT)分为 HT发生组和HT未发生组，比较病灶侧与健 侧、HT发生组和HT未发生组CTP相关参数 值[脑血流量(CBF)、脑血容量(CBV)、平 均通过时间(MTT)、表面通透性(PS)]，并 探讨CTP相关参数值与HT发生的相关性。 结果 52例患者均取得良好CT平扫和CTP图 像，其中36例患者CT平扫图像显示低密 度缺血性病灶，局部脑沟消失；所有患 者CTP图像均可见与临床症状对应的大范 围异常低灌注区。病灶侧CBF、CBV、MTT 值均低于健侧(P<0.05)，PS值高于健侧 (P<0.05)。HT发生组病灶侧CBF、CBV值均 低于HT未发生组(P<0.05)，PS值高于HT未 发生组(P<0.05)。CBV、CBF、PS均与HT发 生具有显著相关性(P<0.05)，其中CBV、 CBF与HT发生呈负相关，PS与HT发生呈正 相关。结论 640层CTP对急性缺血性脑卒 中再灌注患者出现HT具有较好预测价值。

Objective To explore the application of 640-slice CT perfusion imaging (CTP) in the reperfusion therapy of acute ischemic stroke. Methods 52 cases of patients with acute ischemic stroke who were admitted to our emergency department from January 2016 to January 2018 were selected within 4.5 hours of onset, and were given intravenous recombinant tissue plasminogen activator (rt-PA) thrombolytic therapy, and they were given CT plain scan and CTP before treatment. According to whether or not hemorrhagic transformation (HT) occurred after treatment, the patients were divided into HT occurrence group and HT non-occurrence group. The CTP-related parameters [cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), permeability surface (PS)] were compared between the lesion side and the healthy side, HT occurrence group, and HT non-occurrence group. And the correlation between CTP-related parameter and HT occurrence was analyzed. Results All the 52 patients had good CT plain scans and CTP images, and CT plain scans of 36 patients showed low-density ischemic lesions and local disappeared sulcus. All patients had large-scale abnormal hypoperfusion areas corresponding to clinical symptoms in CTP images. The values of CBF, CBV and MTT in the lesion side were lower than those in the healthy side (P<0.05) while the PS value was higher than that in the healthy side (P<0.05). The values of CBF and CBV in the lesion side of HT occurrence group were lower than those of HT non-occurrence group (P<0.05) while the PS value was higher than that in HT non-occurrence group (P<0.05). There was significant correlation between CBV, CBF and PS and HT (P<0.05), and CBV and CBF were negatively correlated with HT, and PS was positively correlated with HT. Conclusion 640-slice CTP has a good predictive value for HT in patients with acute ischemic stroke and reperfusion.