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【文摘发布】可疑等压性脑积水患者的长期预后
Author： Kahlon B, Sjunnesson J, Rehncrona S.
Resource: Neurosurgery. 2007 Feb;60(2):327-32; discussion 332.
Abstract： 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 6 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 6 4.6 mo) and long-term (5.5 6 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.
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作者:admin@医学,生命科学 2011-08-06 17:12
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