术中超声在脑外伤后脑室穿刺中的应用

Application of intraoperative ultrasound in ventricle puncture of traumatic brain injury

目的探讨术中超声在脑外伤后脑室穿刺中的应用价值。方法选取脑外伤后需接受侧脑室穿刺术的患者68例,随机均分为2组,对研究组实施超声引导下侧脑室穿刺术,对照组实施传统盲穿术,分别记录每例穿刺成功所需时间、单次穿刺成功情况及每组的术后并发症情况,并对两组结果进行比较。结果研究组一次穿刺成功率为100%(34/34);手术时间5～12min,平均(6.35±1.51)min;术后无并发症发生。对照组24例一次穿刺成功,成功率70.59%(24/34);手术时间5～17min,平均(11.21±3.10)min;术后8例(8/34,23.53%)出现并发症,分别为穿刺道出血4例、误穿入对侧脑室2例、反复穿刺致使窦道形成1例及脉络丛损伤1例。研究组与对照组间的一次穿刺成功率、穿刺手术时间及术后并发症发生率差异均有统计学意义(P均<0.05)。结论在脑外伤患者的脑室穿刺术中,超声引导法穿刺成功率明显优于传统盲穿法,手术时间明显短于传统盲穿法,并可减少并发症的发生,可在临床推广应用。

Objective To explore the application value of ultrasound for guiding ventricle puncture drainage of traumatic brain injury patients. Methods Sixty-eight patients with traumatic brain injury were enrolled and equally divided into two groups. Patients in study group underwent uitrasound-guided puncture ventricle drainage, while in control group under- went conventional blind-puncture ventricle drainage. The operation time and results were recorded and compared between two groups. Results The success rate of first time puncture and the operation time of study group was 100% （34/34） and 5-12 min （mean [6.35±1.51]min）, of control group was 70.59% （24/34） and 5-17 min （mean [11.21±3.10]min）, respectively （both P〈0.05）. No postoperative complication occurred in study group, while postoperative complications occurred in 8 patients of control group, including puncture tract bleeding （n= 4）, puncture into the offside ventricle （n= 2）, fistula formation caused by muhi-puncture and choroid plexus injury （each n = 1, P 〈 0.05）. Conclusion Ultrasound- guided puncture ventricle drainage is superior to conventional bind-puncture in puncture achievement ratio, operation time and postoperative complications, and can be widely used in clinical practice.