移动式床边CT在导航引导下微创治疗幕上高血压脑出血中的应用价值探讨

Mobile bedside CT-CereTom navigation guidance in minimally invasive treatment of supratentorial hypertensive cerebral hemorrhage

目的 探讨移动式床旁CT（PBCT）——CereTom（美国NeuroLogica公司产品）在导航引导下微创手术（锁孔手术）治疗幕上高血压脑出血中的临床应用及其价值. 方法 对自2010年8月至2013年12月北京军区总医院附属八一脑科医院收治的56例幕上高血压脑出血患者,在手术前使用CereTom行CT导航扫描（19例为床旁CT检查,37例为常规CT检查）,在手术后行CT扫描以了解血肿清除效果. 结果 患者自收入急诊科到手术室开始麻醉的平均时间为（32.05±8.56） min,CT扫描＋术前计划的平均时间为13 min,平均手术时间为（108.49±26.61） min.患者术后血肿清除率平均达96.9％,血肿清除率＞90％的病例数为52例（92.86％）.患者术前GCS评分平均为9分,mRS评分平均为4分,而出院时GCS评分平均升至14分,mRS评分平均降至3分.患者术后6个月总体生存率为94.64％（53/56）,其中57.1％（32/56）恢复良好,28.57％（16/56）合并重残,8.9％（5/56）植物生存,5.4％（3/56）死亡. 结论 应用CereTom可以快速实施导航,其导航引导下的锁孔手术快速、精准、安全有效,手术清除率高,同时其可连续追踪观察,并特别适合于危重患者的床旁检查.

Objective To explore the clinical application and value of mobile bedside CT （PBCT）-CereTom navigation guidance in minimally invasive surgery （keyhole surgery） of supratentorial hypertensive cerebral hemorrhage.Methods Fifty-six patients with supratentorial hypertensive cerebral hemorrhage,admitted to our hospital from August 2010 to December 2013,were chosen in our study; before surgery,CT navigation CereTom line scan （19 with bedside CT examination and 37 with conventional CT examination） was performed; CT scans after surgery was also performed to detect the effect of hematoma removal.Results The average time of these patients from admitting to the Emergency Department to the operating room beginning anesthesia was （32.05±8.56） min,time of CT scan＋median preoperative planning was 13 min （ranged 7-35 min） and mean operative time was （108.49± 26.61） min.Hematoma removal rate reached 96.9% （ranged from 77.9% to 99.4%）,and the number of patients having hematoma removal〉90% was 52 （92.86%）.Preoperative Glasgow coma scale （GCS） scores were 9 points （ranged from 3 to 15） and modified Rankin scale （mRS） scores were 4 points （ranged 2-5）; Glasgow coma scale （GCS） scores were increased to 14 points （ranged from 0 to 15） and mRS scores were 3 points （ranged from 0 to 6）.The overall survival 6 months after surgery was 94.64%（53/56）,including 57.1% （32/56） having good recovery,28.57% （16/56） having combined severe disable,8.9% （5/56） having plant survival,5.4% （3/56） being death.Conclusions PBCT-CereTom navigation can be implemented quickly and keyhole surgery under the guidance of its navigation is fast,accurate,safe and effective; the surgical removal rate is high; continuous follow-up observation can be performed;it is especially suitable for bedside critically ill patients.