改良VPS治疗脑室出血后脑积水的效果及对神经功能、铁离子和水通道蛋白-4的影响  

Effect of Modified VPS on Hydrocephalus After Intraventricular Hemorrhage and Effect on Nerve Function, Ferric Ion and Aquaporin-4

作　　者：郭延兵 李晓辉[1] 王新军 GUO Yanbing;LI Xiaohui;WANG Xinjun(Department of Neurosurgery,Luoyang Central Hospital,Luoyang 471000,China;Department of Pediatric Neurosurgery,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]洛阳市中心医院神经外科,河南洛阳471000 [2]郑州大学第三附属医院小儿神经科,河南郑州450052

出　　处：《河南医学研究》2024年第10期1785-1789,共5页Henan Medical Research

摘　　要：目的 探讨改良脑室-腹腔分流术(VPS)在脑室出血(IVH)后脑积水患者治疗中的应用价值。方法 选取2021年1月至2023年1月洛阳市中心医院收治的102例IVH后脑积水患者,采用简单随机化法分为两组,各51例。对照组接受传统VPS治疗,研究组接受改良VPS治疗。比较两组手术相关指标、神经功能评分[美国国立卫生院卒中量表(NIHSS)]及相关因子[白蛋白商(QAlb)、神经元特异性烯醇化酶(NSE)]、血清铁离子(Fe)、水通道蛋白-4(AQP-4)水平、认知功能[蒙特利尔认知评估量表(MoCA)评分]、生活能力[日常生活能力量表(ADL)评分]、步态障碍评分(Tinetti评分)、并发症及术后6个月情况良好率。结果 研究组通气时间、住院时间、住院费用均较对照组低(P<0.05);术后第7天,研究组NIHSS评分、脑脊液NSE和QAlb、血清Fe和AQP-4水平均较对照组低(P<0.05);研究组术后第6个月MoCA评分、ADL评分、Tinetti评分均较对照组高(P<0.05);研究组并发症发生率较对照组低,术后6个月预后良好率较对照组高(P<0.05)。结论 改良VPS治疗IVH后脑积水患者,可减轻神经功能损伤,恢复认知功能和步态,增强日常生存能力,改善患者预后,且能减少并发症及住院时间,减轻患者负担。Objective To investigate the value of modified ventriculoperitoneal shunt(VPS)in the treatment of hydrocephalus after intraventricular hemorrhage(IVH).Methods A total of 102 patients with IVH hydrocephalus in Luoyang Central Hospital from January 2021 to January 2023 were selected and divided into two groups with 51 cases each by simple randomization method.The control group was treated with traditional VPS,and the study group was treated with improved VPS.Surgery-related indexes were compared between the two groups,as well as neurological function scores[(National Institutes of Health stroke scale,NIHSS)]and related factors[albumin quotient(QAlb),neuron-specific enolase(NSE)],serum ferric ion(Fe),aquaporin-4(AQP-4)levels,cognitive function[Montreal cognitive assessment scale(MoCA)scores],ability to lead a life[activities of daily living(ADL)score],and gait disturbance score(Tinetti score),and to compare the rates of complications and good condition at 6 months postoperatively between the two groups.Results The ventilation time,hospitalization time,and hospitalization cost of the study group were lower than those of the control group(P<0.05).The NIHSS score,cerebrospinal fluid NSE and QAlb,and serum Fe and AQP-4 levels of the study group were lower than those of the control group on the 7th postoperative day(P<0.05).The MoCA score,ADL score,and Tinetti score of the study group were higher than those of the control group on the 6th postoperative month(P<0.05).The study group had a lower complication rate and a higher rate of good prognosis at 6 months postoperatively than the control group(P<0.05).Conclusion Modified VPS in the treatment of IVH hydrocephalus can reduce neurological damage,restore cognitive function and gait,enhance daily survival,improve prognosis,reduce complications and hospital stay,and reduce the burden of patients.

关 键 词：脑室出血后脑积水 脑室-腹腔分流术 神经功能 铁离子 水通道蛋白-4 生活能力 预后 

分 类 号：R741.05[医药卫生—神经病学与精神病学]