氨甲环酸联合逐级调压治疗儿童脑室-腹腔分流术后慢性硬膜下血肿的初步观察  

Preliminary observation of tranexamic acid combined with stepwise pressure regulation in the treatment of chronic subdural hematoma after ventriculoperitoneal shunt in children

作　　者：刘洛同 邓华江 刘亮 官明 彭建华 陈礼刚 Liu Luotong;Deng Huajiang;Liu Liang;Guan Ming;Peng Jianhua;Chen Ligang(Department of Neurosurgery,Affiliated Hospital of Southwest Medical University,Luzhou 646000,China;Luzhou Key Laboratory of Neurological Diseases and Brain Functions,Affiliated Hospital of Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学附属医院神经外科,泸州646000 [2]西南医科大学附属医院神经系统疾病与脑功能泸州市重点实验室,泸州646000

出　　处：《中华神经外科杂志》2022年第6期586-590,共5页Chinese Journal of Neurosurgery

摘　　要：目的初步探讨氨甲环酸联合脑室-腹腔分流阀门逐级调压治疗儿童脑积水脑室-腹腔分流术后慢性硬膜下血肿(CSDH)的临床效果。方法回顾性分析2018年1月至2021年6月西南医科大学附属医院神经外科采用氨甲环酸联合脑室-腹腔分流阀门逐级调压治疗的17例脑积水分流术后CSDH患儿的临床资料。氨甲环酸每日治疗剂量(mg)=750×0.05×(年龄+2)。同时,所有患儿均检测分流管调压阀门的初始压力,并根据患儿的症状和颅内血肿的情况上调压力;分别于调压后3、7、14 d及之后每月复查头颅CT、再次调压。患儿症状缓解且CSDH基本吸收(血肿量≤5 ml)则停止治疗,并继续门诊随访>6个月;每周电话随访患儿,每月复查头颅CT和神经功能Markwalder分级。将治疗效果分为有效和无效:头颅CT或MRI平扫显示血肿吸收或(和)临床症状缓解定义为有效;治疗1个月时血肿量不变、甚至增加和(或)临床症状加重,因药物不良反应等原因不能继续保守治疗或失访,定义为无效。结果17例患儿中,1例失访,16例完成随访,随访时间为(10.1±2.4)个月(8~12个月)。至末次随访,治疗有效12例,无效5例。12例治疗有效的患儿治疗期间调压次数为(2.1±0.6)次(1~3次),上调压力的中位数为3.0 cm H_(2)O(2.0~4.5 cm H_(2)O)(1 cm H_(2)O=0.098 kPa);头痛(10例)、肌力下降(5例)均于治疗2~8周缓解;治疗6个月时12例患儿的血肿均全部吸收;至末次随访,无一例复发,Markwalder分级均为0级。5例治疗无效的患儿中,1例失访;3例转行血肿清除术治疗;1例因患儿服药困难而停药,门诊随访6个月血肿量无变化。结论初步观察发现,采用氨甲环酸联合脑室-腹腔分流阀门逐级调压治疗儿童脑积水脑室-腹腔分流术后CSDH可缓解患儿的症状,安全性和有效性均较好。Objective To investigate the clinical effect of tranexamic acid combined with stepwise pressure regulation of ventriculoperitoneal shunt valve in the treatment of chronic subdural hematoma(CSDH)after ventriculoperitoneal(VP)shunt in children with hydrocephalus.Methods Retro-spectively analyze the clinical data of 17 children with CSDH post VP shunt for hydrocephalus who were treated with tranexamic acid combined with stepwise pressure regulation of VP shunt valve in the Department of Neurosurgery of the Affiliated Hospital of Southwest Medical University from January 2018 to June 2021.Tranexamic acid daily therapeutic dose(mg)=750×0.05×(age+2).During the same period,all children were tested for the initial pressure of the shunt regulator valve,and the pressure was increased according to the symptoms of the child and the condition of intracranial hematoma.The cranial CT and pressure regulation were reviewed monthly after 3,7,14 days and thereafter.Treatment was discontinued when the child′s symptoms improved and the CSDH was mostly absorbed(hematoma volume≤5 ml),and outpatient follow-up lasted for>6 months which included weekly telephone follow-up and monthly head CT and monthly assessment of neurological function using Markwalder grade.The therapeutic effect was divided into effective and ineffective.Head CT or MRI scan showing hematoma resorption or/and clinical symptom relief was defined as effective.Unchanged or even increase of hematoma amount and/or worsening of clinical symptoms at 1 month post treatment,discontinuation of conservative treatment due to adverse drug effect,or loss to follow-up was defined as ineffective.Results Among the 17 children,1 was lost to follow-up,and 16 completed the follow-up.The follow-up time was 10.1±2.4 months(8-12 months).At the last follow-up,12 cases were effective and 5 cases were ineffective.The number of times of pressure regulation in the 12 cases of children who received effective treatment during the treatment was 2.1±0.6 times(1-3 times),and the median increa

关 键 词：血肿 硬膜下 慢性 脑室腹膜分流术 氨甲环酸 治疗结果 逐级调压 

分 类 号：R726.5[医药卫生—儿科]