Tap试验阴性老年iNPH患者行腰大池置管脑脊液压力持续检测的可行性和必要性  

Feasibility and Necessity of Continuous Detection of Cerebrospinal Fluid Pressure in Lumbar Cistern Catheterization in Elderly iNPH Patients with Tap Test Negative

作　　者：郭吉卫 GUO Jiwei(Beijing Changping District Hospital,Beijing 102202,China)

机构地区：[1]北京市昌平区医院,北京102202

出　　处：《中外医学研究》2023年第25期77-81,共5页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的:研究腰椎穿刺脑脊液放液试验(Tap试验)阴性老年特发性正常压力脑积水(iNPH)患者行腰大池置管脑脊液压力持续检测的可行性和必要性。方法:回顾性分析2017年1月—2022年7月北京市昌平区医院收治的86例Tap试验阴性老年i NPH患者的资料,所有患者均在Tap试验后行腰大池置管引流术+脑脊液压力测试,然后行脑室-腹腔(VP)分流术治疗,根据不同预后将86例患者分为预后良好组(n=37)和预后不良组(n=49),根据脑脊液压力(CSFP)与颅内压相关系数(RAP)两者联合诊断最佳截断值分为A组(n=35)与B组(n=51)。比较Tap试验阴性老年iNPH患者VP分流术前后简易精神状态评价量表(MMSE)评分、计时-起立-行走测试(TUGT)时间和排尿评分,比较不同预后患者相关指标,绘制ROC曲线分析CSFP、RAP及两者联合预测Tap试验阴性老年iNPH患者VP分流术预后的价值,比较A组和B组步态不稳、认知障碍、排尿障碍改善率。结果:Tap试验阴性老年iNPH患者VP分流术后1个月MMSE评分高于术前,TUGT时间短于术前,排尿评分低于术前,差异有统计学意义(P<0.05)。预后良好组CSFP、RAP均高于预后不良组,差异有统计学意义(P<0.05);两组性别、平均年龄、Hakim三联征症状构成比较,差异无统计学意义(P>0.05)。两者联合诊断曲线下面积(AUC)大于CSFP、RAP单独诊断,差异有统计学意义(P<0.05)。A组术后1个月步态不稳、认知障碍及排尿障碍改善率均高于B组,差异有统计学意义(P<0.05)。结论:Tap试验阴性老年iNPH患者行腰大池置管脑脊液压力持续检测,通过CSFP、RAP可反映脑室内与周围组织对压力梯度的代偿能力和耐受能力,CSFP、RAP越大,VP分流术的效果越好。Objective:To investigate the feasibility and necessity of continuous detection of cerebrospinal fluid pressure in lumbar cistern catheterization in elderly idiopathic normal pressure hydrocephalus(iNPH)patients with lumbar puncture and cerebrospinal fluid drainage test(Tap test)negative.Method:The data of 86 elderly iNPH patients with Tap test negative who treated in Beijing Changping District Hospital from January 2017 to July 2022 were retrospectively analyzed,all patients were underwent lumbar cistern drainage and cerebrospinal fluid pressure test after Tap test,and then ventriculoperitoneal(VP)shunt was performed.According to different prognosis,86 patients were divided into good prognosis group(n=37)and poor prognosis group(n=49).According to the best cut-off value of cerebrospinal fluid pressure(CSFP)and intracranial pressure correlation coefficient(RAP),the patients were divided into group A(n=35)and group B(n=51).The score of mini-mental state examination(MMSE),time of time-rise-walking test(TUGT)and urination score in elderly iNPH patients with negative Tap test before and after VP shingle were compared,and the relevant indicators of patients with different prognosis were compared,ROC curve was drawn to analyze the value of CSFP,RAP and their combination in predicting the prognosis of VP shunt in elderly iNPH patients with Tap test negative,and the improvement rates of gait unsteady,cognitive disorder and voiding disorder were compared between group A and group B.Result:The MMSE score in elderly iNPH patients with Tap test negative at 1 month after VP shunt was higher than that before surgery,the TUGT time was shorter than that before surgery,and the urination score was lower than before surgery,the differences were statistically significant(P<0.05).The CSFP and RAP in the good prognosis group were higher than those in the poor prognosis group,the differences were statistically significant(P<0.05);there were no significant differences in gender,average age and composition of Hakim triad symptoms between

关 键 词：腰椎穿刺脑脊液放液试验 老年人 特发性正常压力脑积水 腰大池置管脑脊液压力检测 预后 

分 类 号：R742.7[医药卫生—神经病学与精神病学]