脑损伤患者脑室-腹腔分流管堵塞的诊断、治疗及对预后的影响  

The diagnosis, therapy of ventriculoperitoneal shunt obstruction and its effect on brain injury patients'prognosis

作　　者：陈真[1] 华扬[2] 宋为群[1] 陈革[3] 杨远滨[1] 朱琳[1] 

机构地区：[1]首都医科大学附属宣武医院神经康复中心,北京宣外长椿街100053 [2]首都医科大学附属宣武医院超声科 [3]首都医科大学附属宣武医院神经外科

出　　处：《中国康复医学杂志》2005年第9期668-671,共4页Chinese Journal of Rehabilitation Medicine

基　　金：北京市自然科学基金(7052030);国家十五科技攻关项目(2004BA703B08-02);国家自然科学基金面上项目(30370489)

摘　　要：目的:探讨脑损伤患者脑室-腹腔分流管堵塞的早期诊断方法、治疗措施及对患者预后的影响。方法:2002年10月—2004年10月收治的脑室-腹腔分流术后2个月—2年的30例患者,通过分流管超声、连续CT、MRI,脑室分流管造影三种检查方法来判断脑室分流管的分流情况。对于分流管堵塞的患者实行再通术及术后康复治疗。结果:18例诊断为脑室-腹腔分流管堵塞,15例患者进行了再次手术,术后8例患者康复水平较前明显提高,4例呈低反应状态,3例无变化。15例再手术患者手术前和术后半年的GCS评分、FIM评分以及左右脑室直径的比较差异均有显著性意义(P<0.05)。结论:通过分流管超声、动态CT、MRI检查及脑室分流管造影检查并结合临床症状可判断脑损伤患者的脑室-腹腔分流管分流情况。脑室-腹腔分流管再通术及术后康复治疗可改善患者的预后。Objective： To study the diagnosis, therapy of ventriculoperitoneal shunt obstruction and its effect on brain injury patients＇ prognosis. Method： Thirty patients who received ventrieuloperitoneal shunt were examinated by Doppler ultrasound, continuous CT or/and MRI, and ventriculoperitoneal shunt radiography. According to the patients＇ clinical symptoms, whether the shunt obstruction was concluded. Those patients whose ventriculoperitoneal shunt obstruction underwent the operation again. Then those patients obtained rehabilitative therapy after operation. Result： There were 18 patients whose ventriculoperitoneal shunt obstructed, and 15 patients underwent the operation again. There were 8 patients whose rehabilitation outcome improved greatly, and 4 patients who became minimal responsive. There was significant difference between the GCS score before treatment and the one after treatment half a year （P〈0.05）. The standard Barthel score was the same. Conclusion： Doppler ultrasonic, continuous CT or/ and MRT and ventriculoperitoneal shunt radiography can help us draw the conclusion. Active rehabilitative training can improve the patients＇ prognosis. It is very important to find shunt obstruction in the early phase.

关 键 词：脑损伤 脑室-腹腔分流管堵塞 康复 预后 

分 类 号：R651.1[医药卫生—外科学]