作者：何刚，袁学森，王超，高晗

单位：

100076北京市大兴区中西医结合医院神经外科 通信作者：何刚，E-mail：13522842162@163.com

Units：

Department of Neurosurgery, Beijing Daxing District Hospital of Integrated Chinese and Western Medicine, Beijing 100076,China Corresponding author: HE Gang, E-mail: 13522842162@163.com

关键词：

脑积水; 脑室-腹腔分流术; 神经元特异性烯醇化酶; 白蛋白; 并发症;

Keywords：

Hydrocephalus; Ventriculo-peritoneal shunt; Neuron specific enolase; Albumin; Complication

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.181

Funds：

首都卫生发展科研专项（首发2019-4037-07）

摘要：

目的 探究改良脑室-腹腔分流术(VPS)治疗继发性脑积水的效果。方法 选取2015年1月至2019年1月在北京市大兴区中西医结合医院就诊的86例继发性脑积水患者为研究对象,采用随机数字表法分为对照组和观察组,每组43例。对照组进行常规VPS,观察组进行改良VPS。比较两组临床疗效,术前、术后1周、术后2周脑脊液神经元特异性烯醇化酶(NSE)和白蛋白商(QAlb),术前、术后3个月、术后6个月、术后12个月日常生活能力量表(ADL)评分、美国国立卫生研究院卒中量表(NIHSS)评分以及术后12个月并发症发生情况。结果 两组临床疗效比较,差异无统计学意义(P>0.05)。治疗方法与时间在脑脊液NSE、QAlb上存在交互作用(P<0.05);治疗方法、时间在脑脊液NSE、QAlb上主效应均显著(P<0.05);两组术后1、2周脑脊液NSE、QAlb分别低于本组术前,且观察组低于对照组(P<0.05)。治疗方法与时间在ADL、NIHSS评分上存在交互作用(P<0.05);治疗方法、时间在ADL、NIHSS评分上主效应均显著(P<0.05);两组术后3、6、12个月ADL评分分别高于本组术前,NIHSS评分低于本组术前,且观察组术后3、6、12个月ADL评分高于对照组,NIHSS评分低于对照组(P<0.05)。观察组分流管堵塞、引流过度或不足、出血发生率低于对照组(P<0.05)。结论 改良VPS能有效恢复继发性脑积水患者血-脑脊液屏障,提高其日常生活能力,改善神经功能,且安全性好,值得临床推广。

Abstract：

【Abstract】 Objective To explore the effect of modified ventriculo-peritoneal shunt (VPS) in treatment of secondaryhydrocephalus. Methods A total of 86 patients with secondary hydrocephalus who were treated in Beijing Daxing DistrictHospital of Integrated Chinese and Western Medicine from January 2015 to January 2019 were selected as the research objects.They were divided into control group and observation group by random number table method, with 43 cases in each group. Thecontrol group received conventional VPS, and the observation group received modified VPS. The clinical efficacy, the neuron-specific enolase (NSE) and albumin quotient (QAlb) in cerebrospinal fluid before operation, 1 week after operation and 2 weeksafter operation, Activity of Daily Living Scale (ADL) score and National Institute of Health Stroke Scale (NIHSS) score beforeoperation and at 3 months, 6 months, and 12 months after operation and complications at 12 months after operation were comparedbetween the two groups. Results There was no significant difference in the clinical efficacy between the two groups (P > 0.05) .There was an interaction between treatment method and time on cerebrospinal fluid NSE and QAlb (P < 0.05) ; the main effectsof treatment method and time were significant on cerebrospinal fluid NSE and QAlb (P < 0.05) . The cerebrospinal fluid NSEand QAlb of the two groups at 1 week and 2 weeks after operation were lower than those before operation respectively, and thecerebrospinal fluid NSE and QAlb of the observation group were lower than those of the control group (P < 0.05) . There was aninteraction between treatment method and time on ADL and NIHSS scores (P < 0.05) ; treatment method and time had significantmain effects on ADL and NIHSS scores (P < 0.05) ; the ADL scores of the two groups at 3 months, 6 months and 12 months afterthe operation were higher than those before operation, and the NIHSS scores were lower than those before operation respectively,and the ADL scores of the observation group were higher than those of the control group at 3 months, 6 months and 12 months afteroperation, and the NIHSS scores of the observation group were lower than those of the control group (P < 0.05) . The incidence ofobstructed flow tube, excessive or insufficient drainage, and bleeding in the observation group was lower than that in the controlgroup (P < 0.05) .Conclusion Modified VPS can effectively restore the blood-cerebrospinal fluid barrier in patients withsecondary hydrocephalus, improve their daily living ability, and improve neurological function, and has good safety, which isworthy of clinical promotion.

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