继发性低压和负压性脑积水发病机制及治疗

Analysis of therapeutic strategies for secondary low pressure and negative pressure hydrocephalus

目的分析继发性低压性脑积水(low pressure hydrocephalus,LPH)和负压性脑积水(negative pressure hydrocephalus,NegPH)的发病机制及治疗策略。方法回顾性分析15例继发性LPH和NegPH患者的临床资料,经脑室外引流测压确诊8例,根据脑室-腹腔分流术后设定的有效分流阀压确诊7例。5例初发LPH患者采用可调压分流管行脑室-腹腔分流术(ventriculo-peritoneal shunt,VPS),6例分流术后LPH患者予以下调可调压分流管阀门压,3例分流术后NegPH患者经逐步抬高脑室外引流后再次行VPS,1例NegPH患者行第三脑室造瘘术。采用GOS-E评分量表(extended Glasgow outcome scale)评估患者预后。结果15例随访1年,1例LPH及3例NegPH患者出现颅内感染;脑积水引起的临床症状完全改善6例,部分改善7例,无改善2例;脑室大小恢复正常6例,较治疗前缩小8例,无变化1例;LPH患者术后1年的GOS-E评分为5.0(4.0,6.0),NegPH患者为3.5(1.5,4.0),差异具有统计学意义(P<0.05);1例NegPH患者死亡。结论VPS中采用可调压分流管治疗LPH患者的疗效优于NegPH患者,综合治疗手段可有效改善NegPH患者的预后。

Objective To analyze the pathogenesis and therapeutic strategies of secondary low-pressure hydrocephalus(LPH)and negative-pressure hydrocephalus(NegPH).Methods We retrospectively analyzed the clinical data of 15 patients with secondary low-pressure and negative-pressure hydrocephalus.Eight cases were diagnosed by pressure measurement of extraventricular drainage and 7 cases were confirmed according to the effective shunt valve pressure set after the ventriculo-peritoneal shunt(VPS).Five patients with initial LPH underwent ventriculo-peritoneal shunt with adjustable pressure shunt pipe,6 with LPH after VPS were treated with down regulation of the pressure of the adjustable pressure shunt,3 with NegPH after shunt underwent a second VPS after gradual elevation of the extraventricular drainage and 1 with NegPH underwent a third ventriculostomy.GOS-E(Extended Glasgow Outcome Scale)was used to evaluate the prognosis.Results All patients were followed up for 1 year after surgery,1 LPH and 3 NegPH patients developed intracranial infection.The clinical symptoms caused by hydrocephalus were completely improved in 6 case,partially improved in 7 cases and not improved in two cases.The size of ventricles returned to normal level in 6 patients,decreased in 8 and unchanged in 1.The GOS-E score of LPH patients at 1 year after surgery was 5.0(4.0,6.0)and 3.5(1.5,4.0)for NegPH patients,the difference was statistically significant(P<0.05);and 1 NegPH patient died.Conclusion Patients with LPH treated with adjustable pressure shunt during ventriculoperitoneal shunt received better results than patients with NegPH,and comprehensive treatment can effectively improve the prognosis of patients with NegPH.