Long-term outcome in patients with suspected normal pressure hydrocephalus
Long-term outcome in patients with suspected normal pressure hydrocephalus
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DOI：
10.1227/01.neu.0000249273.41569.6e
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发表时间：
2007-02-01
期刊：
影响因子：
4.8
通讯作者：
Rehncrona, Stig
中科院分区：
文献类型：
--
作者：
Kahlon, Babar;Sjunnesson, Johan;Rehncrona, Stig
目的：评估疑似常压脑积水患者分流手术后 6 个月和 5 年的结果。方法：纳入 75 名有常压脑积水症状的患者（平均年龄，72.5 +/- 9 岁）。 54例腰椎输液和/或脑脊液抽检结果呈阳性的患者接受了脑脊液分流术，而21例检测结果呈阴性的患者未接受手术。步行、反应时间、记忆力和相同形式测试被用作基线（手术前）测试，并在短期（6.1 +/- 4.6 个月）和长期（5.5 +/- 1.4 年）随访评估中重复进行。采用Barthel指数评估日常生活功能活动。结果：6个月随访检查时，83%的手术患者步态改善，65%的反应时间改善，46%的记忆力改善，31%的同形测试改善； 96% 的人发现自己主观上得到了改善。由于不相关的死亡率 (37%) 和合并症导致的总体健康状况下降，只有 27 名患者可参加 5 年随访评估。其中 23 名患者接受了分流治疗，步态和反应时间仍有近 40% 的改善，而认知测试中只有不到 10% 的患者有改善。百分之五十六的人报告与术前发现相比主观改善。如果年龄小于 75 岁，则更多患者 (64%) 得到改善；对于75岁以上的患者，只有11%的患者病情有所改善。改善患者的 Barthel 指数较高（P < 0.05）。结论：正常压力脑积水患者从分流手术中受益至少 5 年。高死亡率、合并症和高龄阻碍了良好的长期结果，并强调了患者选择的重要性。
OBJECTIVE: To evaluate the outcome of patients with suspected normal pressure hydrocephalus at 6 months and 5 years after shunt Surgery.METHODS: Seventy-five patients (mean age, 72.5 +/- 9 yr), with normal pressure hydrocephalus symptoms were included. Fifty-four patients with positive lumbar infusion and/or cerebrospinal fluid tap tests received a cerebrospinal fluid shunt, whereas 21 patients with negative test results did not undergo operation. Walk, reaction time, memory, and identical forms tests were used as baseline (before surgery) tests and were repeated at short- (6.1 +/- 4.6 mo) and long-term (5.5 +/- 1.4 yr) follow-up evaluations. Activities of daily life functions were assessed using the Barthel index.RESULTS: At the 6-month follow-up examination, 83% of the operated patients improved in gait, 65% improved in reaction time, 46% improved in memory, and 31% improved in identical forms tests; 96% found themselves subjectively improved. Because of unrelated mortality (37%) and declining general health from comorbidity, only 27 patients were available for the 5-year follow-up evaluation. Twenty-three of these patients had been treated with a shunt and had a remaining improvement in close to 40% in gait and reaction time, whereas fewer than 10% had an improvement in cognitive tests. Fifty-six percent reported subjective improvement compared with preoperative findings. More patients (64%) improved if younger than 75 years; for patients older than 75 years, only 11% of the patients improved. The Barthel index was higher (P < 0.05) in improved patients.CONCLUSION: Patients with normal pressure hydrocephalus benefit from shunt surgery for at least 5 years. High mortality rate, comorbidity, and old age hamper good long-term outcome and emphasize the importance of patient selection.