可调压式分流管在老年人特发性正常压力脑积水治疗中的应用  

作　　者：李国京[1] 王占君[1] 杨志明[1] 郗艳国[1] 

机构地区：[1]河北省沧州市中心医院神经外科,河北沧州061001

出　　处：《中国农村卫生》2013年第04Z期27-29,共3页

摘　　要：目的探讨Codman Hakim可调压式分流管治疗老年人特发性正常压力脑积水（iNPH）的临床效果。方法回顾性分析46例老年人特发性正常压力脑积水患者应用可调压式分流管行脑室腹腔分流术，术前根据患者病史、CT和MRI检查及腰椎穿刺放液试验等临床资料设定分流管调压阀门开放压力，术后根据CT复查结果和患者症状改善程度重新调整阀门压力。结果本组46例患者术后均得到5～14月随访，显效32例（69．6％）；有效10例（21．7％）；无效4例（0．09％）。认知功能障碍者的有效率为64．7％，步态障碍者的有效率为76．2％，尿失禁患者的有效率为62．2％。其中A组（20例）术后6个月后再次行腰穿检查颅内压力，与术前腰穿脑脊液压力测定结果比较。B组（26例）术后按照A组结果设定可调压式分流管初始阀门开放压力，实验结果数据进行统计分析，两组间对照差别有显著意义（P〈0．05）。影像学检查41例脑室系统有不同程度缩小。结论应用可调压式分流管治疗老年人特发性正常压力脑积水是一种安全有效的治疗方法。分流管初始开放压力设定较术前腰穿测压两次平均值低于13％，可以明显减少术后分流管阀门调节次数。Objective To study the influencing factors for Codman--Hakim programmable valve in treatment of the eld idiopathic normal pressure hy- drocephalus. Methods The setting pressure of Codman--Hakim programmable valve was according to the clinical data of 46 cases of eld idiopathic normal pressure hydrocephalus. They were analyzed retrospectively according to the medical history symptoms, CT, MRI diagnosis , test of dranining CSF with lumbar puncture. Results The postoperative follow--up of 5 months to 14 months revealed that the32 cases were cured, 10 cases im- proved, 4cases unimproved. The response rate of patients with gait disturbance was 64.7 %, of patients with amentia was 76.2 o/6, of patients with u- rine incontinence was 62.2%. Control mode of A group depended on the lumbar puncture of CSF compared before and after 6 months of operation. Control mode of B group depended on the statistical data of A. The imaging examination showed the ventricular system of 41 cases were decreased. Conclusions： The Codman-- Hakim programmable valve was an effective Methods for teratment of the eld idiopathic normal pressure hydrocephalus. The initial pressure of the Codman--Hakim programmable valve pressure sets lower than the average 13% of the preoperative mean CSF pressure. The CHPV of regulating times can be efficiently decreased.

关 键 词：特发性正常压力脑积水 脑室一腹腔分流术 可调压式分流管 

分 类 号：R651.11[医药卫生—外科学] R742.7[医药卫生—临床医学]