학술논문
脑脊液压力相关参数预判颅脑损伤后脑积水分流术疗效的研究 / Predicting values of cerebrospinal fluid pressure derived parameters in outcomes of ventriculoperitoneal shunt for post-traumatic hydrocephalus
Document Type
Academic Journal
Author
Source
中华神经外科杂志 / Chinese Journal of Neurosurgery. 35(2):115-119
Subject
Language
Chinese
ISSN
1001-2346
Abstract
目的 探讨腰大池内脑脊液压力(CSFP)和颅内压波幅及其颅内压相关系数(RAP)与颅脑损伤后交通性脑积水患者脑室-腹腔(V-P)分流术疗效的关系.方法 回顾性分析2017年8月至2018年3月上海交通大学医学院附属仁济医院神经外科采用V-P分流术治疗40例颅脑损伤后交通性脑积水患者的临床资料.根据Salomon脑积水分流术的手术效果分级标准进行分级,将患者分为预后相对良好组(1～3级,n=26)和预后不良组(-2～0级,n=14),比较两组患者CSFP和RAP的差异,分析与V-P分流术后疗效之间的关系.结果 单因素分析显示,预后不良组的CSFP值和RAP值[分别为(13.82±4.40) mmHg、(0.66±0.19)]均低于预后相对良好组[分别为(15.12±3.10) mmHg、(0.81±0.13)],均P≤0.001;两组患者的CSFP“剂量”(DCSFP10)和RAP“剂量”(DRAP0.6)比较,预后相对良好组的DCSFP10值[中位数(四分位间距)][84.12(615.22) mmHg/h]和DRAP0.6值[(14.29±6.33)h]均高于预后不良组[分别为34.72(91.62) mmHg/h和(4.01±2.01)h],均P＜0.05.多因素二元logistic回归分析显示,CSFP(OR =2.231,95％ CI:1.264～3.943,P=0.025)和RAP(OR=19.092,95％ CI:3.104～162.103,P=0.001)均是影响两组患者V-P分流术预后的独立危险因素.结论 CSFP及RAP为颅脑损伤后交通性脑积水患者行分流术不良预后的独立危险因素;DCSFP10值及DRAP0.6值均可作为预判颅脑损伤后脑积水分流手术疗效的参数.
Objective To reveal the relationship between cerebrospinal fluid pressure (CSFP),regression of amplitude and pressure (RAP) and operative effect of ventriculoperitoneal (VP) shunt on communicating post-traumatic hydrocephalus.Methods The clinical data of 40 patients with communicating post-traumatic hydrocephalus undergoing VP shunt admitted to Department of Neurosurgical,Renji Hospital,Shanghai Jiaotong University School of Medicine from August 2017 to April 2018 were retrospectively analyzed.The 40 patients were divided into the good prognosis group (1 to 3 degree,n =26) and the poor prognosis group (-2 to 0 degree,n =14) according to Salomon's system of shunt outcome for hydrocephalus at discharge.The cerebrospinal fluid pressure-related parameters were compared between the 2 groups and the relationship between parameters and the surgical effect of VP shunt was analyzed.Results Univariate analysis revealed,Patients in poor prognosis group tended to have lower mean CSFP (13.82 ± 4.40 mmmHg) and mean RAP [correlation coefficient (R) between AMP amplitude (A) and mean pressure (P),0.66 ±0.19] compared to good prognosis group which had mean CSFP (15.12 ±3.10 mmHg) and mean RAP (0.81 ±0.13) (both P≤0.001).CSFP dose of good prognosis group under threshold 10 mmHg (DCSFP10) was higher than that in poor prognosis group [median (inter-quartile range):84.12 (615.22) mmHg/h vs.34.72 (91.62) mmHg/h,P ＜ 0.05).RAP dose of good prognosis group under threshold 0.60 (DRAP0.6) was higher than that in poor prognosis group (14.29 ± 6.33 h vs.4.01:±:2.01 h,P ＜0.05).It was suggested by multiple logistic regression that CSFP (OR =2.231,95％ CI:1.264-3.943,P =O.025) and RAP (OR =19.092,95％ CI:3.104-162.103,P =0.001) were two risk factors associated with poor outcome in operative effect of VP shunt.Conclusions CSFP and RAP are two risk factors associated with poor outcome in patients with communicating post-traumatic hydrocephalus undergoing VP shunt,Both CSFP dose and RAP dose could be used as predicting parameters for effect of post-traumatic hydrocephalus with VP shunt.
Objective To reveal the relationship between cerebrospinal fluid pressure (CSFP),regression of amplitude and pressure (RAP) and operative effect of ventriculoperitoneal (VP) shunt on communicating post-traumatic hydrocephalus.Methods The clinical data of 40 patients with communicating post-traumatic hydrocephalus undergoing VP shunt admitted to Department of Neurosurgical,Renji Hospital,Shanghai Jiaotong University School of Medicine from August 2017 to April 2018 were retrospectively analyzed.The 40 patients were divided into the good prognosis group (1 to 3 degree,n =26) and the poor prognosis group (-2 to 0 degree,n =14) according to Salomon's system of shunt outcome for hydrocephalus at discharge.The cerebrospinal fluid pressure-related parameters were compared between the 2 groups and the relationship between parameters and the surgical effect of VP shunt was analyzed.Results Univariate analysis revealed,Patients in poor prognosis group tended to have lower mean CSFP (13.82 ± 4.40 mmmHg) and mean RAP [correlation coefficient (R) between AMP amplitude (A) and mean pressure (P),0.66 ±0.19] compared to good prognosis group which had mean CSFP (15.12 ±3.10 mmHg) and mean RAP (0.81 ±0.13) (both P≤0.001).CSFP dose of good prognosis group under threshold 10 mmHg (DCSFP10) was higher than that in poor prognosis group [median (inter-quartile range):84.12 (615.22) mmHg/h vs.34.72 (91.62) mmHg/h,P ＜ 0.05).RAP dose of good prognosis group under threshold 0.60 (DRAP0.6) was higher than that in poor prognosis group (14.29 ± 6.33 h vs.4.01:±:2.01 h,P ＜0.05).It was suggested by multiple logistic regression that CSFP (OR =2.231,95％ CI:1.264-3.943,P =O.025) and RAP (OR =19.092,95％ CI:3.104-162.103,P =0.001) were two risk factors associated with poor outcome in operative effect of VP shunt.Conclusions CSFP and RAP are two risk factors associated with poor outcome in patients with communicating post-traumatic hydrocephalus undergoing VP shunt,Both CSFP dose and RAP dose could be used as predicting parameters for effect of post-traumatic hydrocephalus with VP shunt.