特发性正常压力脑积水88例临床诊治分析

Analysis of Clinical Diagnosis and Treatment of 88 Patients with Idiopathic Normal Pressure Hydrocephalus

目的探讨特发性正常压力脑积水的发病特征及不同治疗方法的临床效果。方法回顾性分析2008年6月至2010年6月由单县中心医院神经内科收治的88例特发性正常压力脑积水患者的临床资料,其中62～70岁36例,71～80岁38例,81～89岁14例,对所有患者一般资料和诊治情况进行比较,并分析疗效。结果 81～89岁患者的比例显著低于62～70岁和71～80岁患者的比例(χ2=13.521、15.722,P<0.05),患者以步态障碍为主要临床表现,其次是痴呆和失禁,三种表现比例的差异有统计学意义(χ2=11.054,P<0.05);磁共振成像(MRI)检查比例显著低于腰穿和CT检查(χ2=82.133、82.133,P<0.05);临床误诊或漏诊率为40.91%,误诊及漏诊率较高。腰穿检查后行分流手术治疗的有效率最高为83.33%,其次是腰穿引流术(76.92%)、腰穿放液术(65.63%),未腰穿检查行分流手术的有效率(25%)最低,差异有统计学意义(P<0.05)。结论特发性正常压力脑积水患者临床误诊、漏诊率高,应注意患者年龄和合并症情况,以腰穿和CT为主要检测手段,配合MRI以提高检出率和准确率。

Objective To investigate idiopathic normal pressure hydrocephalus clinical characteristics and different treatment methods of clinical effect.Methods Clinical data of 88 patients with idiopathic normal pressure hydrocephalus from Shan County Central Hospital during Jun.2008 and Jun.2010 were retrospective analyzed and compared by the general information,diagnosis and treatment,and the efficacy.The 88 cases included 36 cases of 62-70 year,38 cases of 71-80 year,and 14 cases of 81-89 year.Results 81-89 year old patient portion was significantly lower than the 62-70 year old and 71-80 year old patient（χ2 = 13.521,15.722,P 0.05）.Gait disturbance was the main clinical manifestation,followed by dementia and incontinence,and the differences of the three manifestations were statistically significant（χ2 = 11.054,P 0.05）;Magnetic resonance imaging（MRI） examination was significantly lower than the lumbar puncture and CT（χ2 = 82.133,82.133,P 0.05）;clinical misdiagnosis or missed diagnosis rate was 40.91%,which was relatively high.Shunt surgery after lumbar puncture had the highest efficacy of 83.33%,followed by lumbar drainage（76.92%）,lumbar puncture fluid technique（65.63%）,shunt surgery without lumbar puncture efficacy（25%） was the lowest,the differences were statistically significant（P 0.05）.Conclusion Idiopathic normal pressure hydrocephalus patients have high clinical misdiagnosis and missed diagnosis rate,the patients age and merge symptoms should be paid due attention;lumbar puncture and CT assisted by MRI are main methods which can improve the detection rate and accuracy.