[1]翟瑄,梁平,周渝冬,等.29例脑积水患儿围手术期颅内压监测及其临床意义分析[J].第三军医大学学报,2016,38(13):1538-1541.
 Zhai Xuan,Liang Ping,Zhou Yudong,et al.Perioperative monitoring of intracranial pressure in 29 children with hydrocephalus and its clinical significance[J].J Third Mil Med Univ,2016,38(13):1538-1541.
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29例脑积水患儿围手术期颅内压监测及其临床意义分析(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
38卷
期数:
2016年第13期
页码:
1538-1541
栏目:
临床医学
出版日期:
2016-07-15

文章信息/Info

Title:
Perioperative monitoring of intracranial pressure in 29 children with hydrocephalus and its clinical significance
作者:
翟瑄梁平周渝冬李禄生吴宣萱张为丹蒋莉
重庆医科大学附属儿童医院:神经外科,神经内科,儿童发育疾病研究教育部重点实验室,儿科学重庆市重点实验室,重庆市儿童发育重大疾病诊治与预防国际科技合作基地
Author(s):
Zhai Xuan Liang Ping Zhou Yudong Li Lusheng Wu Xuanxuan Zhang Weidan Jiang Li

Department of Neurosurgery, Department of Neurology, Key Laboratory of Developmental Diseases in Childhood Co-founded by Chongqing and Ministry of Education, Chongqing Key Laboratory of Pediatrics, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, 400014, China

关键词:
脑积水脑室-腹腔分流术神经内镜第三脑室底造瘘术颅内压儿童
Keywords:
hydrocephalus ventricle-peritoneal shunt endoscopic third ventriculostomy intracranial pressure children
分类号:
R619; R741.04; R742.7
文献标志码:
A
摘要:

目的      探讨脑积水患儿不同术式治疗后颅内压(intracranial pressure ,ICP)的改变及其临床意义。      方法      回顾性分析我科2011年1月至2012年12月住院手术治疗的29例脑积水患儿围手术期的ICP变化,其中分流手术14例,脑室镜下三脑室底造瘘术(endoscopic third ventriculostomy ,ETV)15例。使用脑实质型ICP探头在手术前后连续监测ICP的变化,监测时间72~168 h。      结果      与术前比较,两组术后ICP均有明显下降(P<0.05)。术后连续监测显示两手术组ICP变化明显不同,分流手术组ICP呈持续下降趋势,ETV组ICP术后迅速回升,再呈缓慢下降趋势。可调压管分流组术后24 h内回升到接近术前的水平,此后120 h内逐渐下降至调压阀设定的压力水平。脑室镜手术组术后24~48 h内可出现一过性高颅压,其中肿瘤继发脑积水亚组较先天性脑积水亚组明显,持续时间更长。      结论      ICP监测能准确反映脑积水患儿围手术期颅压变化,术后持续监测有助于准确判断ETV的手术效果。

Abstract:

Objective      To investigate the changes of intracranial pressure (ICP) and its clinical significance in the children with hydrocephalus who treated by different surgeries.       Methods      Clinical data of 29 children with hydrocephalus receiving surgical treatment in our department of neurosurgery from January 2011 to December 2012 were collected in this study and retrospectively analyzed. Fourteen of them underwent ventriculo-peritoneal shunt surgery, and the other 15 received endoscopic third ventriculostomy (ETV). The ICP values in perioperative period were continuously monitored in all patients by brain parenchymatype ICP probe before and after surgery (ranging from 72 to 168 h), and recorded for its clinical significance.       Results      ICP value were significantly declined postoperatively when compared with the preoperative value in all the patients (P<0.05). Results of postoperative continuous monitoring indicated that the changes of postoperative ICP were significantly different between the 2 surgery groups. ICP showed a continuous declining trend in the shunt surgery group, however the pressure rise rapidly after surgery and then decreased slowly in the ETV group. ICP of programmable valve subgroup returned to almost preoperative level within 24 h, and gradually decreased to the level of the setting pressure within 120 h thereafter. There was a transient high intracranial pressure in ETV group within 24 to 48 h postoperatively, and this process was significant and longer lasting in tumors secondary to hydrocephalus subgroup than in congenital hydrocephalus subgroup.       Conclusion      ICP monitoring can accurately reflect intracranial pressure change in the children with hydrocephalus, and postoperative continuous monitoring may help to accurately determine the surgical effect of ETV.

参考文献/References:

[1]翟瑄, 梁平, 夏佐中, 等. 可调压式分流管治疗小儿脑积水的临床观察[J]. 第三军医大学学报, 2011, 33(24): 2614-2616. DOI: 10.16016/j.1000-5404.2011.24.024
[2]Schroeder H W, Niendorf W R, Gaab M R. Complications of endoscopic third ventriculostomy[J]. J Neurosurg, 2002, 96(6): 1032-1040. DOI: 10.3171/jns.2002.96.6.1032
[3]Mobbs R J, Vonau M, Davies M A. Death after late failure of endoscopic third ventriculostomy: a potential solution[J]. Neurosurgery, 2003, 53(2): 384-386.
[4]Hopf N J, Grunert P, Fries G, et al. Endoscopic third ventriculostomy: outcome analysis of 100 consecutive procedures[J]. Neurosurgery, 1999, 44(4): 795-806.
[5]Schwartz T H, Ho B, Prestigiacomo C J, et al. Ventricular volume following third ventriculostomy[J]. J Neurosurg, 1999, 91(1): 20-25. DOI: 10.3171/jns.1999.91.1.0020
[6]Lam S, Reddy G D, Lin Y, et al. Management of hydrocephalus in children with posterior fossa tumors[J]. Surg Neurol Int, 2015, 6(Suppl 11): S346-S348. DOI: 10.4103/2152-7806.161413
[7]Foroutan M, Mafee M F, Dujovny M. Third ventriculostomy, phase-contrast cine MRI and endoscopic techniques[J]. Neurol Res, 1998, 20(5): 443-448.
[8]Roth J, Ram Z, Constantini S. Endoscopic considerations treating hydrocephalus caused by basal ganglia and large thalamic tumors[J]. Surg Neurol Int, 2015, 6: 56. DOI: 10.4103/2152-7806.154467
[9]Elgamal E A. Continuous monitoring of intracranial pressure after endoscopic third ventriculostomy in the management of CSF shunt failure[J]. Minim Invasive Neurosurg, 2010, 53(2): 49-54. DOI: 10.1055/s-0030-1249101
[10]Cinalli G, Spennato P, Ruggiero C, et al. Intracranial pressure monitoring and lumbar puncture after endoscopic third ventriculostomy in children[J]. Neurosurgery, 2006, 58(1): 126-136.
[11]Hayat A, Rodrigues D, Crawford P, et al. External ventricular drains-Can morbidity be reduced. Park I[J]. NeurolSci, 2009, 4(1): 1-3.
[12]Yadav Y R, Parihar V, Pande S, et al. Endoscopic third ventriculostomy[J]. J Neurosci Rural Pract, 2012, 3(2): 163-173. DOI: 10.4103/0976-3147.98222
[13]Stachura K, Grzywna E, Kwinta B M, et al. Endoscopic third ventriculostomy-effectiveness of the procedure for obstructive hydrocephalus with different etiology in adults[J]. Wideochir Inne Tech Maloinwazyjne, 2014, 9(4): 586-595. DOI: 10.5114/wiitm.2014.46076
[14]Nishiyama K, Yoshimura J, Fujii Y. Limitations of Neuroendoscopic Treatment for Pediatric Hydrocephalus and Considerations from Future Perspectives[J]. Neurol Med Chir (Tokyo), 2015, 55(8): 611-616. DOI: 10.2176/nmc.ra.2014-0433
[15]Rapana A, Bellotti A, Iaccarino C, et al. Intracranial pressure patterns after endoscopic third ventriculostomy. Preliminary experience[J]. Acta Neurochir (Wien), 2004, 146(12): 1309-1315. DOI: 10.1007/s00701-004-0377-2

相似文献/References:

[1]翟瑄,梁平,夏佐中,等.可调压式分流管治疗小儿脑积水的临床观察[J].第三军医大学学报,2011,33(24):2614.
 Zhai Xuan,Liang Ping,Xia Zuozhong,et al.Clinical efficiency of programmable shunt valve in treatment of hydrocephalus in children[J].J Third Mil Med Univ,2011,33(13):2614.

更新日期/Last Update: 2016-06-30