Ventriculoperitoneal shunt block: what are the best predictive clinical indicators?
Ventriculoperitoneal shunt block: what are the best predictive clinical indicators?
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DOI：
10.1136/adc.87.3.198
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发表时间：
2002-09-01
影响因子：
5.2
通讯作者：
Thompson, D
中科院分区：
文献类型：
--
作者：
Barnes, NP;Jones, SJ;Thompson, D
目的：评估的预测价值的症状，体征，并伴随着假定脑室腹腔（VP）分流功能障碍的影像学检查结果，通过比较介绍与手术结果和随后的临床course.Methods：前瞻性研究的所有53例患者转诊到儿科神经外科中心1999年4月至11月之间的诊断假定分流功能障碍。记录转诊模式、症状和体征、计算机断层扫描（CT）结果、手术结果和临床结局。定义了两个患者组，一个证实了分流阻滞，另一个假定分流功能正常。症状学，CT扫描结果，以及随后的临床过程中为每组compared.Results：共同的表现特点是头痛，嗜睡，呕吐。所有患者均行CT扫描。37例经手术证实的分流功能障碍，其中34例有分流阻滞，3例有分流感染;与既往成像相比，84%的分流阻滞患者的脑室尺寸增大。对于两个患者组（有和没有分流阻滞），其表现症状的比值比（95%置信区间）为头痛1.5（0.27至10.9），呕吐0.9（0.25至3.65），嗜睡10（0.69至10.7）和发热0.19（0.03至6.95）。每一个心室扩大大于他们已知的基线的患者有一个被证实的阻塞shunt.Conclusions：嗜睡是迄今为止最好的临床预测VP分流阻滞。在这项研究中，头痛和呕吐对急性分流阻滞的预测性较低。在可能的情况下，CT扫描结果应在先前成像的背景下进行解释。我们要提醒的是，并非所有证实的分流道堵塞病例都表现为脑室增大。
Aims: To evaluate the predictive value of symptoms, signs, and radiographic findings accompanying presumed ventriculoperitoneal (VP) shunt malfunction, by comparing presentation with operative findings and subsequent clinical course.Methods: Prospective study of all 53 patient referrals to a paediatric neurosurgical centre between April and November 1999 with a diagnosis of presumed shunt malfunction. Referral pattern, presenting symptoms and signs, results of computed tomography (CT) scanning, operative findings, and clinical outcome were recorded. Two patient groups were defined, one with proven shunt block, the other with presumed normal shunt function. Symptomatology, CT scan findings, and the subsequent clinical course for each group were then compared.Results: Common presenting features were headache, drowsiness, and vomiting. CT scans were performed in all patients. Thirty seven had operatively proven shunt malfunction, of whom 34 had shunt block and three shunt infection; 84% with shunt block had increased ventricle size when compared with previous imaging. For the two patient groups (with and without shunt block), odds ratios with 95% confidence intervals on their presenting symptoms were headache 1.5 (0.27 to 10.9), vomiting 0.9 (0.25 to 3.65), drowsiness 10 (0.69 to 10.7), and fever 0.19 (0.03 to 6.95). Every patient with ventricular enlargement greater than their known baseline had a proven blocked shunt.Conclusions: Drowsiness is by far the best clinical predictor of VP shunt block. Headache and vomiting were less predictive of acute shunt block in this study. Wherever possible CT scan findings should be interpreted in the context of previous imaging. We would caution that not all cases of proven shunt blockage present with an increase in ventricle size.