腰椎穿刺放液试验和腰大池置管脑脊液压力持续测定在特发性正常压力脑积水诊疗中的应用  

Application of tap test and continuous monitoring of intracranial pressure in the treatment of idiopathic normal pressure hydrocephalus

作　　者：杨春[1] 冯军峰[1] 高国一[1] 江基尧[1] 张晓华[1] 郑彦[1] Yang Chun;Feng Junfeng;Gao Guoyi;Jiang Jiyao;Zhang Xiaohua;Zheng Yan(Department of Neurosurgery,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院神经外科,200127

出　　处：《中华神经外科杂志》2019年第2期125-129,共5页Chinese Journal of Neurosurgery

摘　　要：目的 探讨腰椎穿刺脑脊液放液试验(Tap试验)和腰大池置管脑脊液压力持续测定在特发性正常压力脑积水(iNPH)诊疗中的应用价值。 方法 回顾性纳入2013年1月至2018年6月上海交通大学医学院附属仁济医院神经外科收治的253例iNPH患者。Tap试验阳性者行脑室-腹腔(V-P)分流术(简称分流术),对部分Tap试验阴性的患者行腰大池置管脑脊液压力持续12 h监测试验,试验后1个月余再行分流术治疗。术后评估颅内压波幅与颅内压的相关系数(RAP)在iNPH诊治中的临床价值及其预测能力。 结果 253例患者中,行分流术治疗者189例(74.7%),术后临床症状改善者161例(85.2%),未改善者28例(14.8%)。Tap试验阳性的160例患者中,149例行分流术治疗,其中临床症状改善者147例(98.7%),未改善者2例(1.3%)。Tap试验阴性的93例患者中,40例行腰大池置管脑脊液压力持续监测试验,RAP值>0.6的16例行分流术治疗的患者中,临床症状改善者12例,未改善者4例;RAP值≤0.6的24例行分流术治疗的患者中,临床症状改善者2例,未改善者22例。RAP值>0.6者与RAP值≤0.6者的手术预后结果比较差异有统计学意义(χ^2=24.350,P<0.01)。 结论 RAP值>0.6在Tap试验阴性患者的iNPH再筛选中有良好的预测率,具有临床应用价值。Objective To reveal the value of cerebrospinal fluid (CSF) tap test and continuous monitoring of intracranial pressure in the treatment of idiopathic normal pressure hydrocephalus (iNPH).Methods Clinical data of 253 patients with iNPH admitted to Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University from January 2013 to June 2018 were retrospectively analyzed. Patients with positive results of tap test underwent shunt operation. One month after 12 hours of continuous CSF pressure monitoring test, patients with negative results of tap test underwent shunt operation. We evaluated the clinical and prognostic value of RAP [correlation coefficient (R) between AMP amplitude (A) and mean pressure (P)] index in the diagnosis and treatment of iNPH.Results A total of 189 patients underwent shunt operation out of 253 patients. Among them, 161 patients showed improvement post surgery and 28 patients reported no improvement. The overall surgical rate was 74.7% and the surgical efficiency was 85.2 %. The tap test was positive in 160 patients and 149 patients underwent shunt operation. There were 147 cases with improvement of clinical symptoms after shunting while 2 cases had no improvement. The tap test was negative in 93 cases and 40 accepted 12 hours of continuous CSF pressure monitoring test and shunt operation. Improvement was reported in 12 after shunting and 4 remained unchanged among 16 patients with RAP index>0.6, while 2 were improved after operation and 22 were unchanged out of 24 patients with RAP index≤0.6. The outcome difference between those 2 groups (RAP index >0.6 and RAP index ≤0.6) of patients (χ^2=24.350, P<0.01).Conclusion The RAP index >0.6 could also be used as an effective supplement of surgical indication for therapeutic effect of shunting in patients with iNPH.It has clinical application value.

关 键 词：脑积水 正常压力 脑室腹膜分流术 颅内压 脑脊液放液试验 预测价值 

分 类 号：R651.1[医药卫生—外科学]