持续腰大池置管脑脊液压力检测对Tap试验阴性iNPH患者的诊疗价值  

Diagnostic value of continuous lumbar cistern drainage for cerebrospinal fluid pressure measurement in iNPH patients with negative Tap test

作　　者：杜晓光 张法学 李华超 董旭帅 张建斌 殷长江 DU Xiao-guang;ZHANG Fa-xue;LI Hua-chao;DONG Xu-shuai;ZHANG Jian-bin;YIN Chang-jiang(Department of Neurosurgery,Shandong Provincial Third Hospital,Jinan Shandong 250031,China)

机构地区：[1]山东省立第三医院神经外科,山东济南250031

出　　处：《局解手术学杂志》2021年第4期333-336,共4页Journal of Regional Anatomy and Operative Surgery

基　　金：山东省科技厅基金资助项目(Z-2017-1-3-46-5)。

摘　　要：目的探讨腰大池置管持续测定脑脊液压力对腰椎穿刺脑脊液放液试验(Tap试验)阴性的特发性正常压力脑积水(iNPH)患者的诊疗价值。方法选择82例Tap试验阴性的iNPH患者作为研究对象,持续12 h行腰大池置管脑脊液压力测定后行脑室—腹腔分流术。根据颅内压波幅与颅内压相关系数(RAP)值分为2组,RAP≥0.6的34例患者为高RAP组,RAP<0.6的48例患者为低RAP组。比较2组手术前后无障碍直线折返计时行走测试(TUGT)时间、简易精神评价测量表(MMSR)评分和排尿评分,评估2组患者步态不稳、认知障碍、排尿障碍改善率及治疗效果。结果术后1个月,高RAP组TUGT时间较术前及低RAP组明显缩短,MMSR评分较术前及低RAP组明显提高,排尿评分较术前及低RAP组明显降低,差异有统计学意义(P<0.05)。高RAP组术后1个月步态不稳、认知障碍、排尿障碍改善率高于低RAP组,差异有统计学意义(P<0.05)。高RAP组患者脑室—腹腔分流术后疗效总有效率高于低RAP组,差异有统计学意义(P<0.05)。结论Tap试验阴性的iNPH患者经持续12 h腰大池置管脑脊液压力测定再筛查,以RAP≥0.6作为行脑室—腹腔分流术的指标具有较高的诊疗价值。Objective To explore the therapeutic value of continuous measurement of cerebrospinal fluid pressure with lumbar cistern drainage in patients with idiopathic normal pressure hydrocephalus(iNPH)and negative results of lumbar puncture cerebrospinal fluid discharge test(Tap test).Methods A total of 82 iNPH patients with negative Tap test results were selected and performed ventriculoperitoneal shunting after completed the cerebrospinal fluid pressure measurement with continuous lumbar cistern drainage for 12 hours.Patients were divided into two groups according to the regression of amplitude and pressure(RAP)between internal pressure amplitude and intracranial pressure,34 cases with RAP≥0.6 were in high RAP group and 48 cases with RAP<0.6 were in low RAP group.Barrier-free linear reentry Timed-Up-and-Go-Test(TUGT)time,mini-mental state examination(MMSR)score and urination score between the two groups were compared,and the improvement rates of gait disorders,cognitive impairment,urination disorder and curative efficacy between the two groups were evaluated.Results The TUGT time in the high RAP group at the 1st month after the surgery was significantly shorter than those before the surgery and in the low RAP group,the MMSR score was significantly higher than those before the surgery and in the low RAP group,and the urination score was significantly lower than those before the surgery and in the low RAP group,the differences were statistically significant(P<0.05).The improvement rates of gait disorders,cognitive impairment and urination disorder in the high RAP group at the 1st month after the surgery were higher than those in the low RAP group,the differences were statistically significant(P<0.05).The total effective rate in the high RAP group after ventriculoperitoneal shunting was higher than that in the low RAP group,the difference was statistically significant(P<0.05).Conclusion iNPH patients with negative TAP test were screened by cerebrospine fluid pressure measurement after 12 hours of continuous lumbar ciste

关 键 词：脑脊液压力检测 特发性正常压力脑积水 脑脊液放液试验 颅内压波幅 颅内压相关系数 

分 类 号：R742.7[医药卫生—神经病学与精神病学]