可调式分流管治疗特发性正常压力脑积水的疗效分析

Analysis of the therapeutic effect of adjustable shunt on idiopathic normal pressure hydrocephalus

目的 探讨可调式分流管治疗特发性正常压力脑积水(INPH)的疗效.方法 研究对象为汕头市中心医院2016年1月1日—2019年5月30日收治的40例行脑室-腹腔分流术(VPS)的INPH患者,采用随机对照方法将其分为2组,其中20例使用固定压力分流管(对照组),另外20例使用可调式分流管(实验组).通过分析10 m行走试验、简易智能精神状态检查(MMSE)评估2组患者的临床症状改善情况.通过Evans指数(EI)和胼胝体角(CA)的影像学方法来评估患者脑室的改善情况.使用改良的Rankin量表(MRS)以及格拉斯哥预后评分(GOS)评估患者治疗后的预后情况.通过北京版蒙特利尔认知评估量表(MoCA)评估2组的全面认知情况.采用额叶功能评定量表(FAB)和斯特鲁普色词测试(SCWT)评估2组的执行功能.观察并记录2组并发症的发生情况.结果 实验组的10 m行走试验时间及步数、MMSE评分均少于对照组(P<0.05).实验组EI低于对照组,CA大于对照组(P<0.05).实验组MRS评分低于对照组,GOS评分高于对照组(P<0.05).实验组MoCA总分、视觉空间、注意力和执行能力评分均高于对照组(P<0.05).实验组FAB和SCWT评分均高于对照组(P<0.05).实验组术后并发症发生率低于对照组(10%vs.30%,P<0.05).结论 与固定压力分流管相比,可调式分流管行VPS治疗INPH具有更明显的治疗效果以及更低的并发症发生率.

Objective To explore the effect of adjustable shunt in the treatment of idiopathic normal pressure hydrocephalus(INPH).Methods A total of 40 patients with INPH admitted to Shantou Central Hospital from January 1,2016 to May 30,2019 were treated with ventriculoperitoneal shunt(VPS).They were divided into two groups by randomized control method:20 patients were treated with fixed pressure shunt(control group)and 20 patients were treated with adjustable shunt(experimental group).The improvement of clinical symptoms in the two groups was evaluated by analyzing 10 m walking test and Mini-Mental State Examination(MMSE).The improvement of cerebral ventricles was evaluated by Evans index(EI)and callosal angle(CA).The Modified Rankin Scale(MRS)and Glasgow Outcome Scale(GOS)were used to evaluate the prognosis of patients after treatment.The overall cognitive status of the two groups was assessed by the Beijing edition Montreal Cognitive Assessment Scale(MoCA).The executive function of the two groups was assessed by Frontal Assessment Battery(FAB)and Stroop Color and Word Test(SCWT).The complications of the two groups were observed and recorded.Results The test time and step number of 10 m walking test and MMSE scores of the experimental group were lower than those of the control group(P<0.05).The EI and CA in the experimental group were lower than those in the control group(P<0.05).The MRS score of the experimental group was lower than that of the control group,and the GOS score was higher than that of the control group(P<0.05).The total MoCA score,as well as the scores of visual space,attention and executive ability in the experimental group were higher than those in the control group(P<0.05).The scores of FAB and SCWT in the experimental group were higher than those in the control group(P<0.05).The incidence of postoperative complications in the experimental group was lower than that in the control group(10%vs.30%,P<0.05).Conclusions Compared with the fixed pressure shunt,VPS with adjustable shunt is more effective in the treatment of INPH,with lower incidence of complications.