腰大池-腹腔分流术治疗40例交通性脑积水的临床效果观察

Clinical effect of lumboperitoneal shunt on 40 cases of communicating hydrocephalus

目的探讨腰大池-腹腔分流术治疗40例交通性脑积水的临床效果。方法回顾性分析首都医科大学附属北京康复医院神经康复中心自2016年1月至2018年12月期间采用腰大池-腹腔分流术治疗的40例交通性脑积水患者的临床资料,主要临床表现有意识障碍、认知障碍、肌张力增高等。术前头颅CT检查证实存在脑室系统扩大,行腰穿放液试验或腰大池引流试验后症状改善,采用可调压脑脊液分流阀行腰大池-腹腔分流术。结果随访6~24个月,脑积水症状均有不同程度改善,无死亡、无分流管相关感染、无分流管堵塞。术后3个月,患者日常生活能力(ADL)、神经功能缺损评分(NIHSS)、简易精神状态(MMSE)、上肢运动功能(Fugl-Meyer)评分均较术前明显改善(t=2.816、3.483、16.306、14.033,P<0.05);术后6个月,患者ADL、NIHSS、MMSE和Fugl-Meyer评分较术后3个月时的评分进一步改善(t=2.109、16.708、10.449、4.749,P<0.05)。术后3个月,患者Evan’s指数与术前比较差异无统计学意义(P>0.05);术后6个月,患者Evan’s指数较术前明显降低(t=7.602,P<0.05)。结论腰大池-腹腔分流治疗交通性脑积水疗效确切,对中枢神经系统基本无损伤,具有创伤小、恢复快、并发症少等优点。

Objective To investigate the clinical effects of lumboperitoneal shunt(LPS)on 40 cases of communicating hydrocephalus.Methods The clinical data of 40 patients with communicating hydrocephalus treated by LPS from January 2016 to December 2018 in the neurological rehabilitation center of Beijing rehabilitation hospital affiliated to capital medical university were retrospectively analyzed.The main clinical manifestations were conscious disturbance,cognitive disturbance and increased muscle tension.Preoperative cranial CT examination confirmed the existence of ventricular enlargement.After lumbar puncture drainage test or lumbar cistern drainage test,the symptoms were improved.Adjustable pressure cerebrospinal fluid shunt valve was used for LPS.Results 6-24 months follow-up showed that hydrocephalus symptoms improved to varying degrees,and there was no death,shunt-related infection or shunt blockage.At 3 months postoperatively,the activity of daily living(ADL),the national institutes of health stroke scale(NIHSS),mini-mental state examination(MMSE),Fugl-Meyer upper-extremity scores of patients were significantly improved compared with those before surgery(t=2.816,3.483,16.306,4.033;P<0.05).At 6 months postoperatively,the ADL,NIHSS,MMSE,and Fugl-Meyer scores were further improved compared with those at 3 months postoperatively(t=2.109,16.708,10.449,4.749;P<0.05).There was no significant difference between Evan’s index of the patients at 3 months postoperatively and those before surgery.At 6 months postoperatively,Evan’s index of the patients was significantly lower than that before surgery(t=7.602,P<0.05).Conclusion LPS is effective in the treatment of communicating hydrocephalus,and has no damage to the central nervous system.It has the advantages of less trauma,faster recovery and fewer complications.