自制颅脑穿刺辅助装置在脑出血穿刺术中的临床应用效果观察

Clinical effect observation of self-made craniocerebral puncture aid in cerebral hemorrhage puncture

目的研究一种自制颅脑穿刺辅助装置在脑出血穿刺治疗中的应用效果,寻找一种定位快速、简便易操作、经济而又临床疗效好的定位装置。方法选择2016年1月到2017年11月在我院接受脑出血穿刺治疗的患者90例,采用盲法和分配隐藏的方法进行分组和手术,A组采用常规体表测量即盲穿法,B组(试验组)采用自制颅脑穿刺辅助装置定位穿刺法,C组采用立体定向定位穿刺法,统计各组血肿穿刺准确率、血肿清除率(术后即刻、24 h、72 h)、术前准备时间和手术时间、治疗后KPS评分。结果 B组的穿刺准确率显著优于A组(P <0. 001),但低于C组(P=0. 049);在术中、术后24 h、术后72 h血肿清除率B组均显著优于A组(P0=0. 003、P24=0. 005、P72=0. 030),与C组间差异无统计学意义(P0=0. 635、P24=0. 111、P72=0. 134); KPS评分C组明显优于A组(P=0. 027),但B组和C组间无统计学差异(P=0. 988);平均手术时间三组间无统计学差异,而手术准备时间B组明显短于C组(P=0. 021),B组、A组无统计学差异(P=0. 567)。结论自制颅脑穿刺辅助装置定位穿刺法,既具有盲穿法的快速定位、简便易操作的优势,又具备立体定向穿刺法的血肿穿刺准确率高和血肿清除率高、治疗效果好的优点。

Objective: To study the application effect of a self-made assisted craniocentesis device in the puncture treatment of cerebral hemorrhage,and to find a positioning device that is rapid,simple and easy to operate,economical and has good clinical efficacy. Methods: Using randomized controlled methods,from January 2016 to November 2017 90 patients with cerebral hemorrhage puncture treated in our hospital were randomly divided into three groups: group A for the conventional surface measurement is blind tees,group B( experimental group) using self-designed brain biopsy assist device positioning puncture method,and group C by stereotactic core-needle method by the method of blind penetration method and the distribution of hidden grouping for surgery. Statistical analysis was done of hematoma puncture accuracy,hematoma clearance rate( postoperative,24 h,72 h) immediately,the preoperative preparation time and operation time,KPS score after treatment.Results: The puncture accuracy of the experimental group( group B) was significantly better than that of blind puncture( group A)( P < 0. 001),but lower than that of stereotactic puncture( group C)( P = 0. 049). The hematoma clearance rate of the experimental group( group B) was significantly better than that of blind puncture( group A)( P0 = 0. 003,P24 = 0.005,P72 = 0. 030) during the operation,24 hours after the operation and 72 hours after the operation,and there was no statistical difference between the two groups( P0 = 0. 635,P24 = 0. 111,P72 = 0. 134). KPS score of group C was significantly better than that of group A( P = 0. 027),but there was no statistical difference between group B and C( P = 0. 988). There was no significant difference in the average operation time among the three groups,while the preparation time of group B was significantly shorter than that of group C( P = 0. 021),and there was no significant difference between group B and group A( P = 0. 567). Conclusion: The localization and puncture method of self-made auxiliary device for craniocerebral puncture not only has the advantages of rapid localization and simple operation of blind puncture,but also has the advantages of high accuracy,high clearance rate and good therapeutic effect of stereotactic puncture for hematoma.