| Objective:To study the ventricle peritoneal shunt(ventriculo peritoneal shunt,VPS)for adult idiopathic normal pressure hydrocephalus(idiopathic normal pressure hydrocephalus,iNPH)treatment effect to improve the situation.Methods:This study collected 30 patients who were diagnosed as iNPH by neurosurgery in Dalian Central Hospital from June 2017 to June 2019 and were treated with intraventricular shunt.The screening criteria were:(1)at least one of the three symptoms of gait instability,cognitive impairment and urinary incontinence;(2)head CT and head MR examination showed ventricular enlargement,and the Evans index was 0.3.(3)lumbar puncture or ICP monitoring confirmed that ICP?200mmH2 O(1 mmH20=0.0098kPa),and no obvious abnormalities were found in routine and biochemical tests of CSF.(4)no previous subarachnoid hemorrhage,head trauma,congenital hydrocephalus and other brain diseases.(5)except for obstructive hydrocephalus.The second screening criteria:cerebrospinal fluid drainage test or continuous lumbar cistern drainage positive;To passed the first screening tests with a single lumbar puncture drainage of cerebrospinal fluid 30-50 ml or lumbar large pool of cerebrospinal fluid drainage for 72 h(of 150-200 ml/d),according to our usual way of research and evaluation,and symptoms improved criterion,through the various departments and to comprehensive evaluation of cerebrospinal fluid after fluid experiment in a walking function,urinary incontinence and walking gait has a marked improvement of surgical patients into the group.To filter into the group of patients with VPS(ventricle peritoneal shunt),resistance to siphon adjustable voltage shunt valve should be used in all patients,the treatment of this group of patients experience is,will be a pressure regulating valve of the pressure setting of preoperative last measured pressure value increases by lumbar puncture 10-20 mmH2O(to prevent excessive diversion),in the follow-up,according to the clinical symptoms of patients readme and review head imaging ventricular size change situation,through the pressure regulating valve to regulate pressure,each high and low pressure adjustment for 10 to 30 mmH2 O.After 1 year of outpatient follow-up,the follow-up time nodes were 3,6 and 12 months after the surgery,respectively.The follow-up contents included the cognitive function,walking function and urination function,as well as the adjustment of the pressure of the shunt valve after the results of head imaging examination.By comparing the 3,6 and 12 months after surgery on the head CT compared with preoperative head CT Evans index,the change of the width of the third ventricle,preoperative postoperative brain front and middle cerebral artery blood flow rate change by transcranial doppler(TCD),preoperative postoperative sleep quality changes through the Pittsburgh sleep quality index(Pittsburgh sleep quality index,PSQI),adopt SPSS 22.0 the data for statistical analysis,comparative analysis the indicators analysis-the ventricle peritoneal shunt specific therapeutic effect.Results:30 patients with VPS were followed up for 1 year,and the clinical symptoms were improved to different degrees without complications such as infection and tube blockage.The follow-up data of 30 patients were scored(the higher the score,the more severe the disease)according to the iNPH grading and scoring system.The follow-up data at 3,6 and 12 months after the operation showed that the symptoms were significantly improved compared with those before the operation(P<0.01),but there was no statistical difference among the postoperative time points.Imaging studies have found that each ventricle patients postoperative all have different levels of smaller,postoperative 3,6 and 12 months compared with preoperative,Evans index decreased obviously,the difference statistically significant(all P<0.05),the width of the third ventricle and preoperative,postoperative 3 months,6 months and 12 months of the third ventricle width decreased significantly,the difference was statistically significant(all P<0.05),by transcranial doppler(TCD)in patients with preoperative and postoperative bilateral brain front and middle cerebral artery blood flow rate measurement,compared with preoperative,After 3 months,6 months and 12 months of bilateral cerebral blood flow rate significantly faster and the difference was statistically significant(all P<0.05),preoperative and postoperative patients with sleep quality for the quantitative evaluation of concrete by PSQI morpheus quality score,compared with preoperative,postoperative 3 months,6 months,12 months PSQI score has dropped significantly,the difference was statistically significant(all P<0.05).Conclusion:Ventriculoperitoneal shunt is an effective treatment for adult idiopathic normal pressure hydrocephalus,and it can improve the patients' triad,cerebral blood supply and sleep quality. |
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