本文關(guān)鍵詞： 腦室-腹腔分流術(shù) 正常壓力性腦積水 特發(fā)性 治療　出處：《蘇州大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探討腦室-腹腔分流術(shù)(VPS)對特發(fā)性正常壓力性腦積水(iNPH)的臨床療效。方法選取2012年1月至2015年2月間收治的41例iNPH患者,擬診僅依據(jù)臨床表現(xiàn)及影像學(xué)檢查,可調(diào)壓分流閥行VPS治療,其中38例完成術(shù)后隨訪6月,并利用CT、10m行走試驗(yàn)、蒙特利爾認(rèn)知評估量表(MoCA)、尿失禁臨床癥狀評分、改良Rankin量表(mRs)在術(shù)前和術(shù)后對患者進(jìn)行評估、比較分析,了解iNPH患者的臨床特點(diǎn)和VPS治療效果。結(jié)果38例患者術(shù)前影像學(xué)均有可見的腦室擴(kuò)大,EI0.3;術(shù)后6月腦室縮小,比較術(shù)前術(shù)后EI,差異有統(tǒng)計(jì)學(xué)意義(P0.001)。利用10m行走試驗(yàn)評估、比較患者治療前后步速、步長,術(shù)后6月明顯改善(P0.001),步態(tài)改善率為73.7%;MoCA測試結(jié)果顯示術(shù)前本組病人得分在18~25分之間(正常為26~30分),認(rèn)知障礙主要表現(xiàn)在視空間和執(zhí)行功能、注意力和延遲回憶這三個(gè)方面,術(shù)后MoCA總分較術(shù)前提高(P0.05),19例得分大于26分,提示利用MoCA量表去評價(jià)認(rèn)知障礙改善程度時(shí),有50%的改善率。從測試內(nèi)容的各單項(xiàng)去看的話,視空間和執(zhí)行功能、注意力單項(xiàng)改善明顯(P0.001),延遲回憶改善不明顯(P0.05)。術(shù)前23例存在尿失禁患者,術(shù)前術(shù)后評分比較有差異(P0.01),52.2%患者評分進(jìn)步1分以上,mRs整體評估療效,術(shù)后60.5%患者癥狀改善(P0.001)其中34.2%評分進(jìn)步1分,21.1%進(jìn)步2分,5.3%進(jìn)步3分,生活自理患者(mRs評分0-2分)比例術(shù)后73.7%高于術(shù)前52.6%。結(jié)論VPS可以改善大多數(shù)iNPH患者臨床癥狀,其中步態(tài)改善較明顯,尿失禁及認(rèn)知障礙次之,MoCA評估顯示術(shù)后6月認(rèn)知障礙部分改善,其中視空間和執(zhí)行功能、注意力有改善,但記憶功能改善較難。臨床中僅根據(jù)患者臨床癥狀及影像學(xué)擬診可能性iNPH患者建議手術(shù)可望改善患者生活質(zhì)量。
[Abstract]:Objective to investigate the clinical effect of ventricular peritoneal shunt (VPS) on idiopathic normal pressure hydrocephalus. Methods 41 patients with iNPH were selected from January 2012 to February 2015. 38 patients were followed up on June with adjustable pressure shunt valve. The patients were evaluated before and after operation with CTT 10 m walking test, Montreal Cognitive Assessment scale (MEC), Clinical symptom scale of urinary incontinence and modified Rankin scale. The clinical features of iNPH patients and the effect of VPS treatment were analyzed. Results the ventricular dilatation was observed in 38 patients before operation and the ventricular dilatation was observed on June after operation. There was a significant difference in EII before and after operation (P 0.001). The step speed and step length of the patients before and after treatment were compared by 10 m walking test. On June, the improvement rate of gait was 73.7%. The results of MoCA test showed that the scores of the patients before operation ranged from 18 to 25 (normal 26 ~ 30). The cognitive impairment was mainly manifested in visual space and executive function, attention and delayed recall. The total score of MoCA after operation was higher than that of preoperation in 19 cases (P 0.05 or P > 26), which suggested that the improvement rate of cognitive impairment was 50% when using MoCA scale to evaluate the degree of cognitive impairment, and the visual space and executive function could be seen from each item of the test content. The improvement of attention was significant (P 0.001), and the improvement of delayed recall was not significant (P 0.05). There were 23 patients with urinary incontinence before and after operation. There was significant difference in the preoperative and postoperative scores between the two groups (P 0.01 / 52.2%). 60.5% patients after operation improved their symptoms (P 0.001) among them, the 34.2% score improved by 1 score, the 34.2% score improved by 21.1%, the score by 2 points improved by 5. 3%, and the living self care patients by 0-2 scores). The proportion of postoperative 73.7% patients was higher than that of preoperative patients (52.6%). Conclusion VPS can improve the clinical symptoms of most patients with iNPH. The improvement of gait was more obvious than that of urinary incontinence and cognitive impairment. The evaluation of MoCA showed a partial improvement of cognitive impairment in June, in which visual space, executive function and attention were improved. However, it is difficult to improve the memory function. The quality of life of patients with iNPH can be improved only according to the clinical symptoms and the possibility of imaging diagnosis in patients with iNPH.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R651.1

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本文編號：1516885