Overdrainage and shunt technology
Overdrainage and shunt technology
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超排水和分流技术
DOI：
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发表时间：
1995
期刊：
影响因子：
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通讯作者：
S. Kunze
中科院分区：
文献类型：
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作者：
Alfred Aschoff;P. Kremer;C. Benesch;Klaus Früh;A. Klank;S. Kunze
当模拟垂直体位时，传统的差压阀表现出完全非生理的流量，是正常产酒率的2-170倍。虽然这部分由硅管的阻力补偿，硅管的阻力可能产生整个分流系统高达94%的阻力，但高达30-44cmH2O的颅内负压(ICP)是不可避免的后果，随之而来的可能是硬膜下血肿、裂隙脑室和其他众所周知的并发症。现代分流技术提供可编程、静液压和“流量控制”的阀门和反虹吸装置；我们测试了来自7家制造商(56个样品)的13种不同设计，使用带有16个子测试的“海德堡阀门测试清单”。“可编程”阀门可降低但不能排除非生理流量：即使在最高位置，结合标准导管，典型的可编程Medos-Hakim阀门允许流量为93-232毫升/小时，索菲SU-8-阀门86-168毫升/小时，30厘米水。静压瓣膜(Hakim-Lumbar，Chhabra)的作用可以通过日常生活的运动来灭活。大多数阀门中的金属球重量太轻，无法充分减少流量。反虹吸装置高度依赖于外部压力，即皮下压力，这对分流功能有不可预测的影响，临床上有时会出现分流不足。两个新的Orbis-Sigma阀即使在模拟垂直位置(30cmH2O)时也显示出相对生理的流量。1例为血流不足(5.7ml/h)，1例为原发梗阻。到目前为止，这些阀门的排气口是所有阀门中最小的。此外，红宝石别针往往会粘在一起。因此，对抹去和封锁的高度敏感性是不可避免的。在儿科患者中获得的令人鼓舞的结果与一些德国和瑞典医院令人失望的经验形成对比，这表明我们的实验室结果得到了临床结果的证实。对于成年患者来说，严格的血流限制的概念似乎不太合适，因为他们在(夜间)颅内压危象期间需要相对较高的流量。分流超标问题仍未得到解决。
When vertical body position is simulated, conventional differential pressure valves show an absolutely unphysiological flow, which is 2–170 times the normal liquor production rate. Although this is compensated in part by the resistance of the silicon tubes, which may produce up to 94% of the resistance of the complete shunt system, a negative intracranial pressure (ICP) of up to 30–44 cmH2O is an unavoidable consequence, which can be followed by subdural hematomas, slit ventricles, and other well-known complications. Modern shunt technology offers programmable, hydrostatic, and “flow-controlled” valves and anti-siphon devices; we have tested 13 different designs from 7 manufacturers (56 specimens), using the “Heidelberg Valve Test Inventory” with 16 subtests. “Programmable” valves reduce, but cannot exclude, unphysiological flow rates: even in the highest position and in combination with a standard catheter typical programmable Medos-Hakim valves allow a flow of 93–232 ml/h, Sophy SU-8-valves 86–168 ml/h with 30 cmH2O. The effect of hydrostatic valves (Hakim-Lumbar, Chhabra) can be inactivated by movements of daily life. The weight of the metal balls in most valves was too low for adequate flow reduction. Antisiphon devices are highly dependent on external, i.e. subcutaneous, pressure which has unpredictable influences on shunt function, and clinically is sometimes followed by shunt insufficiency. Two new Orbis-Sigma valves showed relatively physiological flow rates even when the vertical position (30 cmH2O) was simulated. One showed an insufficient flow (5.7 ml/h), and one was primarily obstructed. These have by far the smallest outlet of all valves. Additionally, the ruby pin tends to stick. Therefore, a high susceptibility to obliterations and blockade is unavoidable. Encouraging results obtained in pediatric patients contrast with disappointing experiences in some German and Swedish hospitals, which suggests that our laboratory findings are confirmed by clinical results. The concept of strict flow limitation seems to be inadaequate for adult patients, who need a relatively high flow during (nocturnal) ICP crises. The problem of shunt overdrainage remains unsolved.