特发性正常颅压脑积水诊疗规范的探讨  

An investigation for standardized diagnosis and treatment of idiopathic normal-pressure hydrocephalus

作　　者：蒋鸿杰 张建民[1] 傅伟明[1] 郑喆[1] 罗巍[1] 郑宇新[1] 朱君明[1] 

机构地区：[1]浙江大学医学院附属第二医院神经外科,杭州,310009 [2]浙江大学医学院附属第二医院神经外科,杭州310009

出　　处：《中华医学杂志》2016年第21期1648-1651,共4页National Medical Journal of China

摘　　要：目的 探讨特发性正常颅压脑积水（iNPH）的规范化术前评估,分流泵初压的设置,术后随访及调压流程等诊疗环节,以求建立规范化诊疗流程.方法 回顾性分析了浙江大学医学院附属第二医院神经外科中心2011年至2015年来收治的26例iNPH患者（男性21例）,平均年龄65.1岁,研究重点分析了iNPH的诊疗流程、术中分流泵初压设置、分流泵选择、术后调压等环节.结果 经规范化治疗后这26例iNPH患者中24例（92.3％）获得满意疗效,在影像学及临床症状方面得到了良好预后.该中心结合自身诊治经验及国外文献报道,建立了对iNPH的临床规范化诊治流程及随访调压流程,提出选择抗重力分流泵并将低于术前脑脊液压力20 mmH2O（1 mmH2O=0.0098kPa）作为分流泵初压设置可获得较好的临床预后.结论 该中心的诊疗流程符合目前对iNPH患者的规范化诊治,具有较好地临床实用性.Objective To investigate some important issues for diagnosis and treatment of idiopathic normal-pressure hydrocephalus （iNPH）,such as standardized pre-operative assessment,initial pressure value of diverter pump,and pressure regulation during follow-up.Methods Twenty six iNPH patients （21 males） who treated in Department of Neurosurgery of 2nd Affiliated Hospital of Zhejiang University School of Medicine from 2011 to 2015 were analyzed retrospectively.The average age was 60.5 year.The analysis focused on the treatment process of iNPH,initial pressure value of diverter pump,choice of diverter pump,and pressure regulation during follow-up.Results As a result,24 cases （92.3%） had a good prognosis based on their imaging and clinical manifestations.Based on the literature and their clinical experiences,this department established a diagnosis and treatment procedure of iNPH and a pressure regulation procedure for the follow-up of iNPH.Moreover,it is proposed that choosing an anti-gravity diverter pump and making an initial pressure value 20 mmH2O less than pre-surgical cerebrospinal pressure may be beneficial for the prognosis.Conclusion This standardized diagnosis and treatment procedure for iNPH is practical and effective.

关 键 词：特发性正常颅压脑积水 诊疗 脑室腹腔分流术 

分 类 号：R651.1[医药卫生—外科学]