影响正常压力性脑积水分流术的预后因素  

Analysis of prognostic factors for cerebrospinal fluid shunt in patients with normal pressure hydrocephalus

作　　者：王永谦[1] 王维平[1] 于明琨[2] 

机构地区：[1]上海中医药大学附属龙华医院神经外科,200032 [2]上海第二军医大学附属长征医院神经外科

出　　处：《临床神经外科杂志》2012年第6期352-354,共3页Journal of Clinical Neurosurgery

摘　　要：目的探讨影响正常压力脑积水行脑脊液分流手术预后的因素。方法从27例正常压力脑积水病人临床症状、病程、腰穿放液和引流试验等因素分析手术效果。结果术后随访3个月～3年,依照疗效判定标准,显效7例(25.9%);有效15例(55.6%);无效4例(14.8%)。其中以步态不稳改善最明显,以痴呆、尿失禁为主要症状者疗效较差。腰穿测CSF平均压力≥140mmH2O者优于压力<140mmH2O的患者;腰穿压力<140mmH2O,且24hCSF总引流量<250ml、夜间12hCSF引流量<150mL的患者疗效最差。结论对正常压力性脑积水,根据临床表现及脑脊液动力学的变化可以预测NPH分流手术的有效性。Objective To evaluate the factors influencing the shunt of normal pressure hydrocephalus （NPH）. Methods The efficacy of shunt was analyzed according to the clinical symptoms, causes of disease, duration, cerebrospinal fluid （CSF） tap test and CSF external lumbar drainage test. Results Among the 27 shunted patients,7 had a very good outcome, 15 had a good outcome, and 4 had a poor outcome three month after shunt implantation. Patients with gait disturbance had excellent improvement of their clinical signs whereas patients with dementia and urinary incontinence had a gradual improvement after surgical intervention. Patients with an opening CSF pressure over 140 mmH20 following lumbar puncture showed a statistically significant better outcome than those with an opening pressure below 140 mmH20. Only twenty-five percent of the patients with an pulsatile pressure below 140 mmH20 and volume of CSF drainage short of 150 ml during over-night monitoring （8p. m. to 8 a. m. ） were poor responders. Conclusion The results of the clinical examination and CSF dynamics serve as decision aids for predicting the outcome after CSF shunting in NPH patients.

关 键 词：正常压力脑积水 分流手术 预后 

分 类 号：R651.11[医药卫生—外科学]