体内分流测试：一种基于英国分流评估实验室数据的方法。

Shunt testing in-vivo: a method based on the data from the UK shunt evaluation laboratory.

作者信息

Czosnyka Z H, Czosnyka M, Pickard J D

机构信息

Academic Neurosurgical Unit, Addenbrooke's Hospital, Cambridge, UK.

出版信息

Acta Neurochir Suppl. 2002;81:27-30. doi: 10.1007/978-3-7091-6738-0_7.

DOI:10.1007/978-3-7091-6738-0_7

PMID:12168323

Abstract

OBJECTIVES

The objective of the UK Shunt Evaluation Laboratory was to perform an independent testing of hydrodynamic performance of hydrocephalus shunts and provide systematic reviewing for neurosurgeons and patients.

METHODS

Valves were tested long-term in a computer-controlled rig to evaluate their pressure-flow performance both at baseline and under conditions mimicking phenomena, which may alter CSF drainage in vivo. The operating pressures (Poperating) and hydrodynamic resistances (R) of all types of valves, currently in use in the UK, have been evaluated (Codman: Hakim-Precision, Hakim-Programmable, Uni-Shunt, Accu-flo, Holter. Medtronic PS Medical: Delta, Flow Control, Lumbo-peritoneal. NMT: Orbis-Sigma, Omni-shunt, Hakim Valve. Heyer-Schulte: In-line, Pudenz-Flushing, LowProfile. Radionics ContourFlex. Sophy Programmable). 67 patients, who had improved in the past following shunting but had recent recurrence of their clinical symptoms, were admitted to undergo a computerized infusion test through the shunt pre-chamber or Ommaya reservoir implanted prior to shunting. The criterion used to detect shunt underdrainage was an increase in ICP during constant infusion above (Poperating) + R * Infusion rate + 5 mm Hg. The validity of this formula has been confirmed in a laboratory study.

RESULTS

35 patients met the criteria for shunt underdrainage while in 24 normal drainage was demonstrated. Mean ICP achieved during the test was 24 mm Hg in patients with underdrainage versus 14 mm Hg with normally functioning shunts (p < 0.01). Out of 35 patients 25 improved and 10 were seen again to have the test repeated. In 7 patients shunt was blocked again. Only 3 patients with primarily confirmed shunt underdrainage did not improve following revisions. In 8 patients overdrainage related to body posture was confirmed using tilt-test.

CONCLUSIONS

Shunt testing in-vivo is easy, clinically useful and has good prediction power (90%).

摘要

目的

英国分流评估实验室的目标是对脑积水分流装置的流体动力学性能进行独立测试，并为神经外科医生和患者提供系统的评估。

方法

在计算机控制的装置中对阀门进行长期测试，以评估其在基线状态以及模拟可能改变体内脑脊液引流现象的条件下的压力-流量性能。对英国目前使用的所有类型阀门的工作压力（Poperating）和流体动力学阻力（R）进行了评估（Codman：Hakim-Precision、Hakim-Programmable、Uni-Shunt、Accu-flo、Holter。Medtronic PS Medical：Delta、Flow Control、Lumbo-peritoneal。NMT：Orbis-Sigma、Omni-shunt、Hakim Valve。Heyer-Schulte：In-line、Pudenz-Flushing、LowProfile。Radionics ContourFlex。Sophy Programmable）。67例过去分流后病情改善但近期临床症状复发的患者被收治，通过分流术前腔或分流术前植入的Ommaya储液器进行计算机化输液测试。用于检测分流装置引流不足的标准是在恒定输液过程中颅内压升高超过（Poperating）+R×输液速率+5mmHg。该公式的有效性已在实验室研究中得到证实。

结果

35例患者符合分流装置引流不足的标准，24例显示为正常引流。分流装置引流不足的患者在测试期间达到的平均颅内压为24mmHg，而分流装置功能正常的患者为14mmHg（p<0.01）。35例患者中有25例病情改善，10例再次进行测试。7例患者分流装置再次堵塞。只有3例最初确诊为分流装置引流不足的患者在修订后病情未改善。通过倾斜试验在8例患者中证实了与体位相关的过度引流。