急诊跌倒老年人群特发性正常压力脑积水诊治的初步探索

Preliminary Exploration of the Diagnosis and Treatment of iNPH in Emergency Elderly Patients with Falls

中文关键词: 跌倒  老年  特发性正常压力脑积水  腰大池腹腔分流术

英文关键词: fall  elderly  idiopathic normal pressure hydrocephalus (iNPH)  lumbo-peritoneal shunt (LPS)

中文摘要:

      目的 通过对比分析神经外科急诊跌倒致头部外伤老年患者的不同处理方法,探索老年特发性正常压力脑积水(idiopathic normal pressure hydrocephalus,iNPH)的诊疗要点.方法 调查神外急诊自发跌倒老年患者618例,经头颅CT检查提示Evans'指数大于0.3的临床可疑iNPH患者72例,其中男性48例、女性24例.根据患者及家属治疗意愿分为腰大池-腹腔分流术(lumbo-peritoneal shunt,LPS)组(n=15)及观察组(n=57).所有患者定期采用简易智能精神状态量表(mini-mental state examination,MMSE)、改良Rankin (modified Rankin scale,mRS)评级和日本特发性正常压力脑积水评分系统(idiopathic normal pressure hydrocephalus grading scale,iNPHGS)进行评估,并对评估结果进行比较.结果 临床可疑iNPH患者占比11.7％.LPS组所有患者术后三联征等临床症状不同程度好转,mRS评级、MMSE评分和iNPHGS总分较术前改善,差异有统计学意义(均P＜0.05).观察组患者MMSE略有降低,差异无统计学意义.mRS、iNPHGS总分及三联征等临床症状均有不同程度进展.结论 iNPH患者的步态、平衡障碍和认知障碍可能是导致老年人跌倒至医院急诊就诊的重要致病因素,而LPS分流手术可有效改善临床症状.

英文摘要:

      Objective To explore the key points in diagnosis and treatment of idiopathic normal pressure hydrocephalus (iNPH) in elderly patients by comparing the results of different treatments for the emergency elderly patients with falls in neurosurgical department.Methods 618 elderly patients of spontaneous fall were investigated;cranial CT scanning indicated 72 out of the 618 were clinical suspected iNPH patients with Evans' index over 0.3,including 48 male and 24 female;the patients were divided into 2 groups based on the intention of patients and their family members:LPS group (lumbo-peritoneal shunt) (n=15) and observation group (n=57);regular evaluations with MMSE (mini-mental state examination),mRS (modified Rankin scale) and Japanese iNPHGS (idiopathic normal pressure hydrocephalus grading scale) were performed on all the 72 patients and the evaluation results were compared.Results The clinical suspected iNPH patients took up 11.7％ of all the 618 patients;the clinical symptoms of the patients in LPS group were improved at certain degrees after operation and the evaluations of mRS,MMSE and iNPHGS showed out better results than those before operation,the difference was of statistical significance (P ＜ 0.05);the scores of MMSE of the patients in observation group were slightly lower in the 12th of the follow-up but the difference was of no statistical significance;deterioration in mRS and iNPHGS evaluation as well as in clinical symptoms were found in patients in observation group.Conclusions Gait,balance disorder and cognitive impairment of iNPH patients may be an important pathogenic factor that causes the elderly to fall and be sent to the emergency department of hospital;LPS surgery is an effective way to improve clinical symptoms of iNPH patients.