| 175 | 1 | 70 |
| 下载次数 | 被引频次 | 阅读次数 |
目的：探讨脑室腹腔分流术(VP分流术)对老年特发性正常压力性脑积水(INPH)的疗效及影响因素。方法：回顾性分析我科2010年1月～2018年5月收治的78例老年INPH患者的临床资料。采用单因素和多因素Logistic回归分析患者手术效果的影响因素。结果：78名INPH患者中，VP分流术后1年内，步态障碍改善54例(69.23%),认知改善48例(61.54%),小便失禁改善24例(30.77%)。年龄<65岁、女性、步态障碍病程<25月的患者术后症状改善较好(均P<0.05)。多因素Logistic回归分析显示，步态障碍病程<25月是患者预后的独立影响因素(P<0.05)。结论：VP分流术是治疗老年INPH的有效方法，步态障碍持续时间越短分流效果越好。
Abstract：Objective: To investigate the efficacy and influencing factors of ventriculoperitoneal(VP) shunt in elderly idiopathic normal pressure hydrocephalus(INPH). Methods: The clinical data of 78 elderly patients with INPH admitted to our department from January 2010 to May 2018 were retrospectively analyzed. Univariate and multivariate logistic regression analysis were used to explore the influencing factors of surgical outcomes in patients. Results: There were 54 cases(69.23%) had improved gait disturbance, 48 cases(61.54%) had improved cognition, and 24 cases(30.77%) had improved urinary incontinence among 78 INPH patients within 1 year after VP shunt. Postoperative symptom improvement was better in female patients less than 65 years old, with course of gait disorder less than 25 months(all P<0.05). Multivariate Logistic regression analysis showed that the duration of gait disorder less than 25 months was an independent factor for prognosis(P<0.05). Conclusion: VP shunt is an effective treatment for INPH in the elderly, and a short duration of gait disturbance indicates a good shunt effect.
[1] Hakim S,Adams R D.The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure [J].J Neurol Sci,1965,2(4):307-327.
[2] Kuriyama N,Miyajima M,Nakajima M,et al.Nationwide hospital-based survey of idiopathic normal pressure hydrocephalus in Japan:epidemiological and clinical characteristics[J].Brain Behav,2017,7(3):e00635.
[3] 梁玉敏，丁圣豪，吴海波，等.国际和日本特发性正常压力脑积水指南解读[J].中华神经外科杂志，201l,27(4):523-527.
[4] Toma A K,Papadopoulos M C,Stapleton S,et al.Systematic review of the outcome of shunt surgery in idiopathic normal-pressure hydrocephalus[J].Acta Neurochir,2013,155(10):1977-1980.
[5] Bugalho P,Alves L,Ribeiro O.Normal pressure hydrocephalus:a qualitative study on outcome[J].Arq Neuro-Psiquiatr,2013,71(11):890-895.
[6] McGirt M J,Woodworth G,Coon A L,et al.Diagnosis,treatment,and analysis of long-term outcomes in idiopathic normal-pressure hydrocephalus[J].Neurosurgery,2008,62(suppl_2):699-705.
[7] Savolainen S,Hurskainen H,Palj?rvi L,et al.Five-year outcome of normal pressure hydrocephalus with or without a shunt:predictive value of the clinical signs,neuropsychological evaluation and infusion test[J].Acta Neurochir(Wien),2002,144(6):515-523.
[8] 马百涛，魏俊吉，高晶，等.成人特发性正常压力脑积水的外科治疗[J].中华医学杂志，2018,98(31):2485-2488.
[9] Chang S,Agarwal S,Williams M A,et al.Demographic factors influence cognitive recovery after shunt for normal-pressure hydrocephalus[J].Neurol,2006,12(1):39-42.
[10] Razay G,Vreugdenhil A,Liddell J.A prospective study of ventriculo-peritoneal shunting for idiopathic normal pressure hydrocephalus[J].J Clin Neurosci,2009,16(9):1180-1183.
[11] Caruso R,Cervoni L,Vitale A M,et al.Idiopathic normal-pressure hydrocephalus in adults:result of shunting correlated with clinical findings in 18 patients and review of the literature[J].Neurosurg Rev,1997,20(2):104-107.
[12] Meier U,Miethke C.Predictors of outcome in patients with normal-pressure hydrocephalus[J].J Clin Neurosci,2003,10(4):453-459.
[13] Delwel E J,de Jong D A,Avezaat C J J.The prognostic value of clinical characteristics and parameters of cerebrospinal fluid hydrodynamics in shunting for idiopathic normal pressure hydrocephalus[J].Acta Neurochir (Wien),2005,147(10):1037-1043.
[14] 李国京，王占君，杨志明，等.特发性正常压力脑积水术前评估及手术策略[J].现代中西医结合杂志，2013,22(10):1061-1063.
[15] Virhammar J,Laurell K,Cesarini K G,et al.The callosal angle measured on MRI as a predictor of outcome in idiopathic normal-pressure hydrocephalus[J].J Neurosurg,2014,120(1):178-184.
[16] Garcia-Armengol R,Domenech S,Botella-Campos C,et al.Comparison of elevated intracranial pressure pulse amplitude and disproportionately enlarged subarachnoid space(DESH)for prediction of surgical results in suspected idiopathic normal pressure hydrocephalus[J].Acta Neurochir,2016,158(11):2207-2213.
[17] Chatzidalds E M,Barlas G,Condilis N.Brain CT scan indexes in the normal pressure hydrocephalus:predictive value in the outcome of patients and correlation to the clinical symptonm[J].Clair,2008,79(5):353.
[18] Klinge P,Hellstr?m P,Tans J,et al.One-year outcome in the european multicentre study on iNPH[J].Acta Neurol Scand,2012,126(3):145-153.
基本信息:
中图分类号:R651.1
引用信息:
[1]孙拯,刘彦廷,罗然,等.老年特发性正常压力性脑积水VP分流术的效果及影响因素分析[J].巴楚医学,2022,5(01):44-48.
基金信息:
国家自然科学基金项目(No:81701278)
2022-03-30
2022-03-30