颅骨成形术对去骨瓣减压术后并发脑积水病人脑室-腹腔分流术后分流量的影响  

Effect of cranioplasty on shunt flow of ventriculoperitoneal shunt in patients with hydrocephalus after decompressive cranioplasty

作　　者：张鸿日[1] 徐玖麟 彭静华[2] 郝晓伟[1] 陈宇航 郭孝龙[1] ZHANG Hong-ri;XU Jiu-ling;PENG Jing-hua;HAO Xiao-wei;CHEN Yu-hang;GUO Xiao-long(Department of Neurosurgery,First Affiliated Hospital,Henan University of Science and Technology,Luoyang 471003,China;Department of Neurology,First Affiliated Hospital,Henan University of Science and Technology,Luoyang 471003,China)

机构地区：[1]河南科技大学第一附属医院神经外科,河南洛阳471003 [2]河南科技大学第一附属医院神经内科,河南洛阳471003

出　　处：《中国临床神经外科杂志》2023年第5期331-333,共3页Chinese Journal of Clinical Neurosurgery

基　　金：河南省高端人才国际化培养(0120180099);河南省医学科技攻关省部共建项目(SB201901066)。

摘　　要：目的探讨颅骨成形术对去骨瓣减压术后并发脑积水病人脑室-腹腔分流术后分流量的影响。方法2018年1月至2021年5月前瞻性收集去骨瓣减压术后并发脑积水病人18例,先行脑室-腹腔分流术,再行颅骨成形术。分流术使用成人可调压抗虹吸分流套装,分流阀放置于耳后。颅骨成形术前、术后7 d,将0.1 ml 5%葡萄糖注射液注入贮液囊,20 min后经储液囊取脑脊液0.1 ml,应用血糖仪检测残余葡萄糖浓度。结果颅骨成形术后7 d储液囊葡萄糖残余浓度[(9.2±4.8)mmol/L]较术前[(6.1±3.6)mmol/L]明显上升(P<0.01)。术后CT复查显示11例脑室扩大,5例变化不明显;分流管压力阀档位下调3例,保持原档位13例。结论去骨瓣减压术后并发脑积水病人,脑室-腹腔分流术后行颅骨成形术,脑脊液分流量减少,部分病人需要将分流阀压力下调。Objective To explore the effect of cranioplasty on the shunt flow of ventriculoperitoneal shunt(VPS)in patients with hydrocephalus after decompressive craniectomy.Methods Eighteen patients with hydrocephalus after decompressive craniectomy were prospectively collected from January 2018 to May 2021.VPS was performed first in all patients,followed by cranioplasty.The shunt is performed using an adult adjustable pressure anti-siphon shunt set with a shunt valve placed behind the ear.Before and 7 days after cranioplasty,0.1 ml 5%glucose injection was injected into into the reservoir of the shunt valve,then 0.1 ml of cerebrospinal fluid was collected from the reservoir of the shunt valve 20 min later and the residual glucose concentration was detected by a blood glucose meter.Results Seven days after cranioplasty,the residual concentration of glucose in the fluid reservoir[(9.2±4.8)mmol/L]was significantly higher than that[(6.1±3.6)mmol/L]before cranioplasty(P<0.01).Postoperative CT reexamination showed ventricle enlargement in 11 patients and no obvious change in 5 patients.The pressure valve was adjusted in 3 patients,and not in 13 patients.Conclusions For patients with hydrocephalus after decompressive craniectomy undergoing VPS,cerebrospinal fluid shunt volume reduces after cranioplasty,and some patients need to lower the shunt valve pressure.

关 键 词：去骨瓣减压术 脑积水 脑室-腹腔分流术 颅骨成形术 分流量 

分 类 号：R742.7[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]