脑室—腹腔分流术治疗特发性正常压力性脑积水临床疗效的研究

发布时间：2018-02-17 01:21

本文关键词： 脑室-腹腔分流术正常压力性脑积水特发性治疗　出处：《苏州大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的探讨脑室-腹腔分流术(VPS)对特发性正常压力性脑积水(iNPH)的临床疗效。方法选取2012年1月至2015年2月间收治的41例iNPH患者,拟诊仅依据临床表现及影像学检查,可调压分流阀行VPS治疗,其中38例完成术后随访6月,并利用CT、10m行走试验、蒙特利尔认知评估量表(MoCA)、尿失禁临床症状评分、改良Rankin量表(mRs)在术前和术后对患者进行评估、比较分析,了解iNPH患者的临床特点和VPS治疗效果。结果38例患者术前影像学均有可见的脑室扩大,EI0.3;术后6月脑室缩小,比较术前术后EI,差异有统计学意义(P0.001)。利用10m行走试验评估、比较患者治疗前后步速、步长,术后6月明显改善(P0.001),步态改善率为73.7%;MoCA测试结果显示术前本组病人得分在18~25分之间(正常为26~30分),认知障碍主要表现在视空间和执行功能、注意力和延迟回忆这三个方面,术后MoCA总分较术前提高(P0.05),19例得分大于26分,提示利用MoCA量表去评价认知障碍改善程度时,有50%的改善率。从测试内容的各单项去看的话,视空间和执行功能、注意力单项改善明显(P0.001),延迟回忆改善不明显(P0.05)。术前23例存在尿失禁患者,术前术后评分比较有差异(P0.01),52.2%患者评分进步1分以上,mRs整体评估疗效,术后60.5%患者症状改善(P0.001)其中34.2%评分进步1分,21.1%进步2分,5.3%进步3分,生活自理患者(mRs评分0-2分)比例术后73.7%高于术前52.6%。结论VPS可以改善大多数iNPH患者临床症状,其中步态改善较明显,尿失禁及认知障碍次之,MoCA评估显示术后6月认知障碍部分改善,其中视空间和执行功能、注意力有改善,但记忆功能改善较难。临床中仅根据患者临床症状及影像学拟诊可能性iNPH患者建议手术可望改善患者生活质量。
[Abstract]:Objective to investigate the clinical effect of ventricular peritoneal shunt (VPS) on idiopathic normal pressure hydrocephalus. Methods 41 patients with iNPH were selected from January 2012 to February 2015. 38 patients were followed up on June with adjustable pressure shunt valve. The patients were evaluated before and after operation with CTT 10 m walking test, Montreal Cognitive Assessment scale (MEC), Clinical symptom scale of urinary incontinence and modified Rankin scale. The clinical features of iNPH patients and the effect of VPS treatment were analyzed. Results the ventricular dilatation was observed in 38 patients before operation and the ventricular dilatation was observed on June after operation. There was a significant difference in EII before and after operation (P 0.001). The step speed and step length of the patients before and after treatment were compared by 10 m walking test. On June, the improvement rate of gait was 73.7%. The results of MoCA test showed that the scores of the patients before operation ranged from 18 to 25 (normal 26 ~ 30). The cognitive impairment was mainly manifested in visual space and executive function, attention and delayed recall. The total score of MoCA after operation was higher than that of preoperation in 19 cases (P 0.05 or P > 26), which suggested that the improvement rate of cognitive impairment was 50% when using MoCA scale to evaluate the degree of cognitive impairment, and the visual space and executive function could be seen from each item of the test content. The improvement of attention was significant (P 0.001), and the improvement of delayed recall was not significant (P 0.05). There were 23 patients with urinary incontinence before and after operation. There was significant difference in the preoperative and postoperative scores between the two groups (P 0.01 / 52.2%). 60.5% patients after operation improved their symptoms (P 0.001) among them, the 34.2% score improved by 1 score, the 34.2% score improved by 21.1%, the score by 2 points improved by 5. 3%, and the living self care patients by 0-2 scores). The proportion of postoperative 73.7% patients was higher than that of preoperative patients (52.6%). Conclusion VPS can improve the clinical symptoms of most patients with iNPH. The improvement of gait was more obvious than that of urinary incontinence and cognitive impairment. The evaluation of MoCA showed a partial improvement of cognitive impairment in June, in which visual space, executive function and attention were improved. However, it is difficult to improve the memory function. The quality of life of patients with iNPH can be improved only according to the clinical symptoms and the possibility of imaging diagnosis in patients with iNPH.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.1

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