慢性意识障碍合并脑积水的临床特征与疗效分析

目的探讨慢性意识障碍(DOC)合并脑积水的临床特征与治疗效果。方法回顾性分析首都医科大学三博脑科医院2014年1月—2017年12月收治的43例慢性意识障碍合并脑积水患者的临床资料。分析指标主要包括:病因、临床表现、影像学表现、意识障碍程度、发生脑积水的时间及治疗效果。结果在同期收治的120例慢性意识障碍患者中,43例患者(35.8%)被诊断为脑积水接受了分流手术治疗。本组患者中,导致脑积水的原发病因主要为颅脑创伤(18例,41.8%)和蛛网膜下腔出血(11例,25.6%);意识障碍为植物状态者11例(25.6%),最小意识状态者17例(39.5%)。脑积水患者初始症状多表现为意识下降(74.4%)、消化不良(58.1%)和肌张力增高(39.5%)。不同意识障碍程度的患者出现脑积水的时间也存在差异,严重患者(CRS-R评分<6分)脑积水主要发生在1个月内(72.8%);中度患者(CRS-R评分6~9分)和轻度患者(CRS-R评分>9分)患者多发生在4~12周,分别占60.9%和48.8%,但是不同组别差异无统计学意义(P=0.1003)。分流手术后患者症状多有不同程度的改善,其中CRS-R评分总体改善患者达77.4%,消化功能改善达75%,肌张力改善达55%。结论慢性意识障碍患者合并脑积水起病隐匿,无特殊临床表现;在影像学表现方面需与脑萎缩导致的脑室扩张鉴别。分流手术能在很大程度上改善脑积水的临床预后。

Clinical characteristics and therapeutic effect of hydrocephalus with chronic disorders of consciousness

Objective To analyze the clinical characteristics and therapeutic effect of hydrocephalus secondary to chronic disorder of consciousness(DOC).Methods The clinical data of 43 patients with hydrocephalus secondary to chronic DOC in Sanbo Brain Hospital from January 2014 to December 2017 were analyzed retrospectively,including etiology,clinical features,imaging characteristics,degree of consciousness,initial clinical manifestations of hydrocephalus and treatment results.Results Of 120 patients,43 were diagnosed as hydrocephalus and received shunt operation,accounting for 35.8%.The primary injury of hydrocephalus mainly included 18 cases of traumatic brain injury(42%)and 11 subarachnoid hemorrhage(25.6%),11 vegetative state(VS)(25.6%),17 minimally consciousness state(MCS)(39.5%).The initial symptoms of hydrocephalus were decreased consciousness(74.4%),dyspepsia(58.1%)and increased muscle tension(39.5%).The time of secondary hydrocephalus was different in different consciousness states.Hydrocephalus mainly occurred in severe patients(CRS-R<6 points)within 1 month(72.8%).Moderate patients(CRS-R6-9)and mild patients(CRS-R>9 points)mostly occurred in 4-12 weeks,accounting for 60.9%and 48.8%respectively,there was no statistical difference among different groups(P=0.1003).After shunting operation,the symptoms of the patients were improved in different degrees.The overall improvement of CRS-R score was 77.4%.The digestive function was 75%,and muscle tension was 55%.Conclusions The secondary hydrocephalus in patients with chronic DOC is occult and has no specific clinical features.It is necessary to distinguish it from ventricular dilation caused by brain atrophy.Shunt operation can improve the clinical results of hydrocephalus to a great extent.