老年特发性正常压力脑积水患者的手术治疗及中期随访  

Surgical management and mid-term follow-up of idiopathic normal pressure hydrocephalus in geriatric patients

作　　者：王长春[1] 王作伟[1] 袁庆国[1] 王兴文[1] 

机构地区：[1]卫生部北京医院神经外科,100730

出　　处：《中华老年医学杂志》2011年第8期664-666,共3页Chinese Journal of Geriatrics

摘　　要：目的评价使用可调压分流管治疗老年人特发性正常压力性脑积水的短期和中期疗效。方法通过腰穿放液试验和腰大池外引流试验，选择29例患者行脑室腹腔分流手术。利用MMSE评分和10米行走试验对患者进行随访。结果术后短期内患者步态及认知改善明显，中期随访发现症状改善率下降，3例患者分流管堵塞，1例出现硬膜下积液，1例患者死于肺部感染，2例患者随访期间死于心脏疾病。结论腰穿放液试验和腰大池外引流试验对预测分流术是否有效具有较高的准确性，脑室腹腔引流术可以改善患者的近期症状，手术的中期疗效下降。采用可调压分流管可以提高手术疗效。Objective To evaluate the short-term and mid-term outcomes in geriatric patients with idiopathic normal pressure hydrocephalus treated with adjustable valve. Methods The 29 patients were selected for the ventriculo-peritoneal shunt by the means of preoperative lumbar tap test and external lumbar drainage test. All patients were assessed by Mini Mental State Examination （MMSE） and timed 10-meter walk test. Results Short-term improvement in gait disturbance and cognitive function could be achieved obviously, and mid-term improvement could not be sustained. The 3 patients had shunt obstruction, 1 had subdural hygroma. 1 case died of pulmonary infection and 2 died of cardiac disease. Conclusions The lumbar tap test and external lumbar drainage test are highly prognostic procedures for identifying patients with idiopathic normal pressure hydrocephalus who mostly likely benefit from shunt surgery. The short-term improvement can be achieved, whereas mid-term improvement can not be sustained. Surgical outcome can be improved by the use of adjustable valve.

关 键 词：脑积水 正常压力 脑室腹膜分流术 

分 类 号：R651.1[医药卫生—外科学]