Abstract：
OBJECTIVE: This study compares transcranial Doppler (TCD) Pulsatility Index (PI) and Resistivity Index (RI) with intra-operative CSF opening pressure measured by manometric technique during ventriculoperitoneal (V-P) shunt in children with hydrocephalus.
METHODS: It was a prospective, hospital-based study performed among patients diagnosed with hydrocephalus. Patients had TCD ultrasonography before V-P shunt. The TCD sonography was repeated within 1 week post-op, and at 1 month post-op. The PI and RI were retrieved after insonating the middle cerebral artery. Ventricular CSF opening pressure was measured. Associations between TCD indices and CSF pressure were determined using the t-test and the Wilcoxon rank /Mann-Whitney tests where the normality test failed. A p-value of < 0.05 was considered significant for associations.
RESULTS: Fifty-two patients were enrolled with a mean age of 9.9 ± 11.5 months. Of these, 41 (78.8%) were aged ≤ 12 months. The mean CSF opening pressure was 21.4 ± 9.0. When raised, ICP was defined as opening pressure > 15 cm of H2O, high PI (≥ 1.19), and high RI (> 0.8) diagnosed it with a sensitivity of 55% and 50%, respectively. The mean pre-operative PI (1.17 ± 0.56) reduced to 0.96 (Z = - 2.032, p = 0.042), while that of RI (0.66 ± 0.17) also decreased to 0.58 (t = 2.906, p = 0.044) after V-P shunt surgery. A strong positive correlation exists between a reduction in PI and RI after V-P shunt (r = 0.743, p = 0.014).
CONCLUSIONS: Both PI and RI significantly decrease following V-P shunt, but a single reading has a poor sensitivity in predicting ICP.
METHODS: It was a prospective, hospital-based study performed among patients diagnosed with hydrocephalus. Patients had TCD ultrasonography before V-P shunt. The TCD sonography was repeated within 1 week post-op, and at 1 month post-op. The PI and RI were retrieved after insonating the middle cerebral artery. Ventricular CSF opening pressure was measured. Associations between TCD indices and CSF pressure were determined using the t-test and the Wilcoxon rank /Mann-Whitney tests where the normality test failed. A p-value of < 0.05 was considered significant for associations.
RESULTS: Fifty-two patients were enrolled with a mean age of 9.9 ± 11.5 months. Of these, 41 (78.8%) were aged ≤ 12 months. The mean CSF opening pressure was 21.4 ± 9.0. When raised, ICP was defined as opening pressure > 15 cm of H2O, high PI (≥ 1.19), and high RI (> 0.8) diagnosed it with a sensitivity of 55% and 50%, respectively. The mean pre-operative PI (1.17 ± 0.56) reduced to 0.96 (Z = - 2.032, p = 0.042), while that of RI (0.66 ± 0.17) also decreased to 0.58 (t = 2.906, p = 0.044) after V-P shunt surgery. A strong positive correlation exists between a reduction in PI and RI after V-P shunt (r = 0.743, p = 0.014).
CONCLUSIONS: Both PI and RI significantly decrease following V-P shunt, but a single reading has a poor sensitivity in predicting ICP.
摘要：
目的：这项研究比较了经颅多普勒（TCD）搏动指数（PI）和电阻率指数（RI）与脑积水患儿脑室腹膜（V-P）分流术中通过测压技术测量的脑脊液开放压力。
方法：这是一个前瞻性的，在诊断为脑积水的患者中进行了基于医院的研究。患者在V-P分流术前进行TCD超声检查。术后1周内重复进行TCD超声检查，术后1个月。PI和RI在大脑中动脉超声后恢复。测量心室CSF开放压力。使用t检验和Wilcoxon秩/Mann-Whitney检验确定TCD指数和CSF压力之间的关联，其中正态检验失败。<0.05的p值被认为对于关联是显著的。
结果：纳入52例患者，平均年龄9.9±11.5个月。其中,41例(78.8%)年龄≤12个月。平均CSF开放压力为21.4±9.0。当举起时，ICP定义为打开压力>15cmH2O，高PI（≥1.19），和高RI（>0.8）诊断为55％和50％的敏感性，分别。术前平均PI(1.17±0.56)降至0.96(Z=-2.032,p=0.042),V-P分流手术后RI（0.66±0.17）也降至0.58（t=2.906，p=0.044）。V-P分流后PI和RI的降低之间存在强正相关（r=0.743，p=0.014）。
结论：V-P分流后PI和RI均显著降低，但单一读数对预测ICP的敏感性较差。
方法：这是一个前瞻性的，在诊断为脑积水的患者中进行了基于医院的研究。患者在V-P分流术前进行TCD超声检查。术后1周内重复进行TCD超声检查，术后1个月。PI和RI在大脑中动脉超声后恢复。测量心室CSF开放压力。使用t检验和Wilcoxon秩/Mann-Whitney检验确定TCD指数和CSF压力之间的关联，其中正态检验失败。<0.05的p值被认为对于关联是显著的。
结果：纳入52例患者，平均年龄9.9±11.5个月。其中,41例(78.8%)年龄≤12个月。平均CSF开放压力为21.4±9.0。当举起时，ICP定义为打开压力>15cmH2O，高PI（≥1.19），和高RI（>0.8）诊断为55％和50％的敏感性，分别。术前平均PI(1.17±0.56)降至0.96(Z=-2.032,p=0.042),V-P分流手术后RI（0.66±0.17）也降至0.58（t=2.906，p=0.044）。V-P分流后PI和RI的降低之间存在强正相关（r=0.743，p=0.014）。
结论：V-P分流后PI和RI均显著降低，但单一读数对预测ICP的敏感性较差。
