可调压分流管LPS术和VPS术治疗交通性脑积水患者的疗效

Study on the efficacy of LPS and VPS with adjustable pressure shunt in patients with communicating hydrocephalus

目的探究可调压分流管腰大池腹腔分流术(LPS)和侧脑室腹腔分流术(VPS)对交通性脑积水患者疗效与血清红细胞分布宽度(RDW)、中枢神经特异性蛋白(S100B)、转化生长因子-β1(TGF-β1)的影响及预后相关因素分析。方法前瞻性选取2018-01—2021-11在成都中医药大学附属资阳医院收治的交通性积水患者300例为研究对象。按随机数字表法将300例患者随机分为研究组与对照组各150例,对照组行VPS术治疗,研究组行LPS术治疗。比较2组术后6个月疗效、加拿大神经病学量表(CNS)、改良Rankin量表(mRS)评分、术后1周RDW、S100B、TGF-β1水平与术后并发症。根据术后是否发生迟发性颅内出血(DICH)将患者分为DICH组与非DICH组,采用二元Logistic回归分析DICH发生影响因素。结果2组疗效存在明显差异,研究组优于对照组(93.33%vs 83.33%)(χ^(2)=7.278,P<0.05)。2组治疗后的CNS评分,较治疗前均显著升高(7.96±0.81 vs 5.06±0.56/7.01±0.69 vs 5.05±0.65),mRS评分均显著降低(2.03±0.42 vs 4.07±0.65/2.85±0.39 vs 3.98±0.55)(t=16.213/11.353、32.285/9.281,P<0.05),且研究组CNS评分(7.96±0.81 vs 7.01±0.69)高于对照组,mRS评分(2.03±0.42 vs 2.85±0.39)均低于对照组(t=10.935、17.522,P<0.05)。与治疗前相比(2.21±0.31/2.22±0.34、16.35±2.34/16.87±2.26、2718.50±703.58/2798.08±729.76),2组患者治疗后的S100B、RDW、TGF-β1水平(1.28±0.27/1.73±0.32、12.58±1.58/14.28±1.55、1664.76±625.59/2304.26±692.44)均显著降低(t=27.707/12.853、16.353/11.575、13.708/6.012,P<0.05),且治疗后研究组S100B、RDW、TGF-β1(1.28±0.27、12.58±1.58、1664.76±625.59)均低于对照组(1.73±0.32、14.28±1.55、2304.26±692.44)(t=13.163、9.407、8.393,P<0.05)。研究组患者术后DICH与总并发症发生率均低于对照组(χ^(2)=14.451,P<0.05)。多因素Logistic回归分析显示,年龄、糖尿病、高血压、术后1周内调节分流管阀门、术后硬膜下有积液均为交通性脑积水患者术后DICH发生的相关影响因素(P<0.05)。结论可调压分流管LPS术相比VPS术治疗交通性脑积水效果更好,可有效改善患者神经损伤情况,降低RDW、S100B、TGF-β1水平,减少术后并发症发生率,且高龄、糖尿病、高血压、术后1周内调节分流管阀门、术后硬膜下有积液均为交通性脑积水患者术后DICH发生的相关危险因素。

Objective To explore the efficacy of adjustable pressure shunt lumbar peritoneal shunt(LPS)and lateral ventriculoperitoneal shunt(VPS)in patients with communicating hydrocephalus,serum red blood cell distribu⁃tion width(RDW),central nervous system specific protein(S100B),transformation Analysis of the influence of growth factor-β1(TGF-β1)and prognostic factors.Methods A total of 300 patients with traffic-related hydrops who were ad⁃mitted to our hospital from January 2018 to November 2021 were prospectively selected as the research subjects.Ac⁃cording to the random number table method,300 patients were randomly divided into the study group and the control group,150 cases in each,the control group was treated with VPS,and the study group was treated with LPS.The cura⁃tive effect,Canadian Neurology Scale(CNS),Modified Rankin Scale(mRS)score,RDW,S100B,TGF-β1 levels and postoperative complications at 1 week after operation were compared between the two groups.According to whether de⁃layed intracranial hemorrhage(DICH)occurred after operation,the patients were divided into DICH group and non-DICH group.Binary Logistic regression was used to analyze the influencing factors of DICH.Results There was a significant difference in the therapeutic efficacy between the two groups,and the treatment group in the study group was higher than that in the control group(93.33%vs 83.33%)(χ^(2)=7.278,P<0.05).After treatment,the CNS scores in both groups were significantly increased(7.96±0.81 vs 5.06±0.56/7.01±0.69 vs 5.05±0.65),and the mRS scores were signifi⁃cantly decreased(2.03±0.42 vs 4.07±0.65/2.85±0.39 vs 3.98±0.55)(t=16.213/11.353,32.285/9.281,P<0.05),and the CNS score of the study group(7.96±0.81 vs 7.01±0.69)was higher than that of the control group,and the mRS score(2.03±0.42 vs 2.85±0.39)were lower than the control group(t=10.935,17.522,P<0.05).Compared with before treat⁃ment(2.21±0.31/2.22±0.34,16.35±2.34/16.87±2.26,2718.50±703.58/2798.08±729.76),the levels of s100B,RDW and TGF-β1 in the two groups after treatment(1.28±0.27/1.73±0.32,12.58±1.58/14.28±1.55,1664.76±625.59/2304.26±692.44)were significantly decreased(t=27.707/12.853,16.313/11.575,13.708/6.012,P<0.05),and the study group s af⁃ter treatment,RDW,TGF-β1(1.28±0.27,12.58±1.58,1664.76±625.59)were lower than those in the control group(1.73±0.32,14.28±1.55,2304.26±692.44)(t=13.163,9.407,8.393,P<0.05).The incidences of postoperative DICH and total complications in the study group were lower than those in the control group(χ^(2)=14.451,P<0.05).Multivariate Logistic regression analysis showed that age,diabetes mellitus,hypertension,adjustment of shunt valve within 1 week af⁃ter operation,and postoperative subdural effusion were all related factors for postoperative DICH in patients with com⁃municating hydrocephalus(P<0.05).Conclusion Compared with VPS,the adjustable pressure shunt LPS has better ef⁃fect in the treatment of communicating hydrocephalus,which can effectively improve the nerve damage of patients,re⁃duce the levels of RDW,S100B,TGF-β1,and reduce the incidence of postoperative complications.In addition,ad⁃vanced age,diabetes,hypertension,adjustment of shunt valve within 1 week after operation,and postoperative subdural effusion are all related risk factors for postoperative DICH in patients with communicating hydrocephalus.