Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
Neurol India. 2024 May 1;72(3):585-589. doi: 10.4103/ni.ni_999_22. Epub 2024 Jun 30.
In hydrocephalus patients, after ventriculoperitoneal (VP) shunt, decrease in pulsatility index (PI) correlates with decrease in ventricle size. Also, increase in PI is noted in obstructed or malfunctioning VP shunts. However, previous studies were either done in infants and children or included patients of all age groups. Our aim was to compare PI before and after successful VP shunt surgery in adult patients and also the trend of transcranial Doppler (TCD) parameters for 3 days after surgery.
A prospective, observational study was done in 20 adult patients undergoing VP shunt. Clinical features, vitals, Evans index, and TCD parameters were noted in the preoperative period. A computed tomography (CT) head was repeated 4-6 h after surgery, and the position of ventricular end of shunt was confirmed and Evans index was calculated. The vitals and TCD parameters were noted at same time and for the next 2 days. Repeated measures analysis of variance (ANOVA) and paired t-test were uses for statistical analysis.
A total of 18 patients were included for statistical analysis. The mean preoperative PI was 1.19 ± 0.24 and the postoperative PI after surgery was 0.97 ± 0.17, 0.97 ± 0.23, and 0.94 ± 0.21 (P = 0.0039) on postoperative day (POD) 1 (POD1), POD2, and POD3, respectively. The mean preoperative value of Evans index was 0.37 ± 0.06 and there was statistically significant (P = < 0.001) reduction to 0.33 ± 0.07 after VP shunt surgery. The change in PI and change in Evans index were found to be positively correlated (r = 0.34 and P = 0.0013).
The decrease in PI after VP shunt surgery correlates with decrease in ventricular size. Any increase in PI in the postoperative period should raise the suspicion of malfunctioning of VP shunt.
在脑积水患者中，脑室-腹腔（VP）分流术后搏动指数（PI）降低与脑室缩小相关。此外，VP 分流器阻塞或功能障碍时也会出现 PI 增加。然而，以前的研究要么是在婴儿和儿童中进行的，要么是包括所有年龄段的患者。我们的目的是比较成人患者 VP 分流术后成功前后的 PI，并观察术后 3 天经颅多普勒（TCD）参数的趋势。
对 20 例行 VP 分流术的成年患者进行前瞻性、观察性研究。记录术前临床特征、生命体征、Evans 指数和 TCD 参数。术后 4-6 小时重复头颅 CT，确认脑室端分流管位置并计算 Evans 指数。同时记录生命体征和 TCD 参数，并在接下来的 2 天内进行记录。采用重复测量方差（ANOVA）和配对 t 检验进行统计学分析。
共有 18 例患者纳入统计分析。术前平均 PI 为 1.19 ± 0.24，术后 PI 分别为 0.97 ± 0.17、0.97 ± 0.23 和 0.94 ± 0.21（P = 0.0039），术后第 1 天（POD1）、第 2 天（POD2）和第 3 天（POD3）。术前平均 Evans 指数为 0.37 ± 0.06，VP 分流术后明显降低（P = < 0.001）至 0.33 ± 0.07。PI 的变化和 Evans 指数的变化呈正相关（r = 0.34，P = 0.0013）。
VP 分流术后 PI 的降低与脑室缩小相关。术后 PI 任何增加都应怀疑 VP 分流器功能障碍。
