非交通性脑积水神经内镜术后腰椎穿刺的重要性  

Importance of lumbar puncture after neuroendoscopy in non-communicating hydrocephalus

作　　者：康庄[1,2] 胡志强[1] 黄辉[1] 戴缤[1] 关峰[1] 朱广通[1] 王邵恒[1,2] 毛贝贝[1,2] 任乐宁[1,2] 

机构地区：[1]首都医科大学附属北京世纪坛医院神经外科,实习医生100038 [2]哈尔滨医科大学,150001

出　　处：《中国微侵袭神经外科杂志》2011年第7期314-316,共3页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：北京世纪坛医院科研基金(编号:2008-16;2009-23)

摘　　要：目的探讨非交通性脑积水病人在神经内镜下行第三脑室底造瘘术(ETV)后腰椎穿刺的重要性。方法回顾性分析39例非交通性脑积水病人ETV术后的临床资料,均表现为颅高压;根据年龄分为儿童组(34例)和成人组(5例),均隔日一次行腰椎穿刺,测量和记录颅内压变化。结果儿童组ETV后早期颅内压降至正常范围后持续升高,于第3天达高峰,其后呈下降趋势,于第11天恢复正常;成人组ETV后早期颅内压明显降低后逐渐升高,第5天达高峰,余变化趋势同儿童组。两组各时间点腰椎穿刺初、末压差别均有统计学意义(P<0.05)。随访1年,儿童组腰椎穿刺治疗有效31例,无效3例;成人组腰椎穿刺治疗有效4例,无效1例。腰椎穿刺治疗无效的4例病人均再次行脑室-腹腔分流术。结论 ETV后腰椎穿刺有利于蛛网膜下腔和蛛网膜颗粒的开放,减少脑脊液流动阻力,提高其顺应性和缓冲能力,重建脑脊液循环。Objective To explore the importance of lumbar puncture after neuroendoscopic third ventriculostomy（ETV） in patients with non-communicative hydrocephalus.Methods Clinical data after ETV in 39 patients with non-communicative hydrocephalus were analyzed retrospectively.High intracranial pressure（ICP） was presented in all the patients,and the patients were divided into child group（n=34） and adult group（n=5） according to age.Lumbar puncture was performed every other day in all the patients,and the changes of ICP were measured and recorded.Results The early ICP declined to the normal and then increased after ETV,reached the peak on the third day postoperatively,declined after that and recovered to the normal on the eleventh day in child group.The ICP reached the peak on the fifth day postoperatively in adult group,and the other changes were similar to child group.There was a statistical significance in difference between the initial and last pressures of lumbar puncture at every time point in both the groups（P0.05）.During a follow-up period of 1 year,the treatment of lumbar puncture was effective in 31 cases and ineffective in 3 in child group,and effective in 4 cases and ineffective in 1 in adult group.Ventriculo-peritoneal shunt was performed in 4 patients with ineffective lumbar puncture.Conclusions Lumber puncture after ETV is beneficial for open of subarachnoid space and arachnoid granulations,reducing the resistance of cerebrospinal fluid flow,enhancing compliance and buffering capacity,and rebuilding cerebrospinal fluid circulation.

关 键 词：脑积水 脊椎穿刺 颅内压 脑室造口术 

分 类 号：R742.7[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]