The Value And Significance Of The Cerebrospinal Fluid Tap Test Efficiency Of Normal Pressure Hydrocephalus Patients After Prediction

Objective: Normal pressure hydrocephalus (NPH) is the mainmechanism of obstruction of cerebrospinal fluid circulation way, cerebrospinalfluid accumulation in the ventricular system, the ventricle dilation. Patientswith NPH have the following characteristics it only occurs in the elderly,patients with resistance, tolerance was significantly lower than young adults;generally have cerebral hemorrhage, subarachnoid hemorrhage, meningitisand other medical history; the typical clinical symptoms for the instability ofgait, impaired memory and urinary incontinence, often appear a, two orsimultaneously; the elderly people often accompanied by neural dysfunctiondiseases, such as senile cerebral atrophy，Alzheimer’s syndrome, the clinicalmanifestation is similar to NPH. At present the common treatments for shunt,with the ventriculo-peritoneal shunt(VPS), in vivo lifetime indwelling foreignbody, combined with the characteristics, postoperative complications (such asintracranial infection, infection of incision, split over, drainage tube piercingintestinal tract) incidence rate and mortality rate was significantly higher thanother similar diseases, and operation efficiency is low, the preoperative shunteffect estimate, to highlight the most important operation effect. With theaging of society to become aggravated, the disease is more and more popular,the effective rate of treatment of the disease, to avoid postoperativecomplications is difficult, is also the research hotspot.The cerebrospinal fluid tap test (TT) is the test efficiency is the earliestestablished on the NPH diagnosis and prediction of operation, its principle isto simulate shunt, temporary drainage of cerebrospinal fluid, and its clinicalmanifestation after assessment, according to the results of prediction toimprove the situation of patients with shunt. It is characterized by simple operation, little injury to patients, and can measure intracranial pressure,drainage tube choose the appropriate pressure, avoid excessive drainage anddrainage is not sufficient. This study is a retrospective analysis of20cases ofTT positive and negative NPH patients, compared to improve the preoperativelevel after operation, in order to explore the lumbar paracentesis test whetherthere are clinical application value in the treatment of NPH.Methods: This research used the review research method, research objectselection since2010July to2013December in23patients of Neurology,Second Hospital of Hebei Medical University and the clinical diagnosis ofnormal pressure hydrocephalus. Specific inclusion criteria:①60~85years;the clinical manifestations: gait ataxia,cognitive impairment and urinaryincontinence triad appear one or more; the head CT scan shows the ventricleand frontal horn index (Evans index) greater than30%; the intracranialpressure is less than180mmH2O; the patients with cerebral hemorrhage,subarachnoid hemorrhage, meningitis history; the previous no similar NPHtriad expression; and all the participants or their authorized known risks mayoccur in experiment, and signed the informed consent. Specifically excludedthe patient or his authorized person for personal reasons for refusing toparticipate in the test; the diagnosis of NPH, but may also have clinicalsymptoms similar to patients. For3patients with senile nervous dysfunctiondisease, the final selection of patients with a total of20cases, and inaccordance with the following criteria: gait assessment: walking functionbarrier (0points); to walk, but not in equilibrium state (1); need outside help towalk (2minutes); completely not standing or walking (3points). Bladderfunction evaluation: normal (0points);frequent micturition, urgency ofurination (1points); total urinary incontinence (2points). The assessment ofintelligence: Mini Mental State Examination (the Mini-Mental StateExamination, MMSE,27~30), normal (0points);21~26, mild mentalretardation (1points);10~20, moderate intellectual disabilities (2points);0~9,severe mental disorder (3), complete gait assessment, bladder functionevaluation, intelligence assessment, three assessment score before and after operation by3points or more to improve, or below2for noimprovement.including13cases of TT positive patients,7cases of TTnegative patients,11male patients,9female patients, with an average age of74±1.8(67~80). Signed in20patients or its authorized person test theinformed consent,5days before surgery to the lumbar puncture, drainage ofcerebrospinal fluid30~35ml,underwent ventriculo-peritoneal shunt, routinepostoperative administration of antibiotics to prevent infection and brain nervenutrition drugs. Quantitative assessment of drainage, drainage after24hoursbefore and1weeks after the shunt in patients with "triad", and followed up for1years, the clinical symptoms of patients were improved statistics.Results:In20patients, including13cases of TT positive patients,8male patients(61.5%),5cases of female patients (39.5%), mean age74±1.8(71~77),7cases of TT negative patients,3male patients (42.8%),4cases offemale patients (57.2%), average age75±2.5(67~80) years old. In20patients only in a ventriculo-peritoneal shunt cases, TT positive were11cases(84.6%) improved,there were7males (87.5%),4cases of female (80%),among them1weeks after surgery to improve gait in11cases,1years afterthe improvement was9cases,1weeks cognitive function improvement was13cases,1years after the improvement was10cases, urinary incontinence in1weeks after improvement was9cases, after1years has improved in7cases,postoperative complications:1cases of intracranial infection; TT negativepatients2cases (28.6%) improved,1cases (male33.3%),1cases of female(25%), among them1weeks after surgery to improve gait in4cases,1yearsafter the improvement was2cases,1week cognitive function improvementoccurred in3cases,1years after the improvement was1cases, urinaryincontinence in1weeks after improvement was1cases,1years afterimproved in1cases, postoperative complications:1cases of subdural effusion,1cases of wound infection.P=0.022<0.05Conclusion: TT positive patients had postoperative efficiency (84.6%)was higher than that of negative patients (28.6%), and P=0.022<0.05, therewas significant difference,indicate that the prediction on the test liquid puncture to improve the situation of NPH patients have certain applicationvalue and the clinical significance, can be combined with the indication ofclinical situations that the brain ventricular peritoneal shunt operation. The testdata in combination with other literature data, the patients with NPH after1weeks of VPS improvement rate of more than1years later, it is revealed thatthe VPS has the limitation in the treatment of NPH. In the exclusion ofexternal factors, the disease may progress is the primary reason. At present,the specific cause of NPH is unknown, VPS is just to solve the clinicalsymptoms, not cure, with the passage of time, the sicker patients,ventriculardilation degree increase, in the simple application of a fixed pressure drainagetube in the treatment of NPH effect is gradually weakened, patients may facethe risk of re operation, therefore, application pressure regulating tubedrainage treatment in the clinical application of NPH can avoid excessive orlong-term drainage unfavorable factors for intracranial pressure changes.