原发性正常压力脑积水术前评估的临床价值

发布时间：2018-05-31 03:37

本文选题：原发性正常压力脑积水 + 脑室-腹腔分流术　；参考：《中国临床神经外科杂志》2016年01期

【摘要】：目的探讨术前评估在原发性正常压力脑积水(INPH)治疗中的意义。方法 2010年1月至2013年5月收治INPH患者26例,术前给予腰大池置管,均进行脑脊液引流试验(Tap试验);对Tap试验有效的患者,进行控制性脑脊液引流定压试验(通过腰大池置管调整颅内压高低,观察患者临床症状,从而确定分流管压力),决定是否手术及选择多少压力下进行脑室-腹腔分流术。结果 26例患者中,20例术前评估有效,进行脑室-腹腔分流术;6例不宜手术治疗。术后随访1年,19例患者临床症状均得到改善,其中3例分别于术后3、6、7个月再次出现不适症状,将可调压分流泵再调整后症状改善;1例因术后感染死亡。结论对INPH通过腰大池置管进行Tap试验和定压试验的术前评估,能显著提高手术的有效率,降低并发症,在INPH的治疗中有一定的临床意义。
[Abstract]:Objective to evaluate the value of preoperative evaluation in the treatment of primary normal pressure hydrocephalus (INPHL). Methods from January 2010 to May 2013, 26 patients with INPH were treated with lumbar cistern catheterization before operation. All patients were treated with cerebrospinal fluid drainage test and Tap test. The controlled cerebrospinal fluid drainage and pressure-setting test was carried out (the cranial pressure was adjusted by placing a tube in the large lumbar cistern to observe the clinical symptoms of the patients, so as to determine the pressure of shunt tube, to decide whether to operate and to choose how many pressures to perform the ventriculoperitoneal shunt. Results among 26 patients, 20 cases were evaluated effectively before operation, 6 cases were not suitable for operation. The clinical symptoms of 19 patients were improved after 1 year follow up, 3 of them reappeared discomfort after 3 months and 7 months, and 1 patient died of postoperative infection after readjusting the adjustable pressure shunt pump. Conclusion the preoperative evaluation of Tap test and fixed pressure test for INPH through lumbar cistern catheterization can significantly improve the effective rate of operation and reduce complications. It has certain clinical significance in the treatment of INPH.
【作者单位】：解放军第三医院神经外科;解放军第323医院高压氧科;
【分类号】：R742.7

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