一种新形式的PBL教学-腰椎穿刺脑脊液滴数和压力关系初探  

A new form of PBL: the study of relationships between the drop speed of lumbar puncture and CSF pressure

作　　者：俞海 陈嬿 黄虑 YU Hai;CHEN Yan;HUANG Lv(Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院神经内科,上海200040 [2]复旦大学附属华山医院教育处,上海200040

出　　处：《中国毕业后医学教育》2018年第1期74-76,共3页Chinese Journal of Graduate Medical Education

摘　　要：尝试一种新的问题式学习模式,带领实习医师和住院医师探究不同型号穿刺针穿刺时脑脊液压力和滴数的关系,指导临床实践。将2名实习医师、2名住院医师以及1名带教老师组成研究小组,使用自制压力调节装置和腰穿模拟人进行研究,分别测定7号针/9号针穿刺针测得的静水压80 mm H_2O、180 mm H_2O、300 mm H_2O时的滴数结果,并进行分析讨论。结果显示:9号针压力300 mm H_2O、180 mm H_2O、80 mm H_2O时滴数分别是120滴/分、84滴/分、34滴/分;7号针压力分别是30滴/分、20滴/分、10滴/分。9号针/7号针穿刺脑脊液滴数基本呈线性关系,在同一个压力下滴数约为4倍的关系,通过泊肃叶定律(Poiseuille定律)证实。正常40~50滴/分对应的约是90~110 mm H_2O(9号针符合),用以指导临床工作激发实习医师和住院医师的临床科研动力。此方法为初探,还需要进一步验证。In order to practise a new form of PBL,residents and interns of the training base were guided to investigate the relationships between cerebrospinal fluid pressures and the numbers of drops with different sizes of puncture needles during lumbar punctures.This study aimed to offer references for clinical practice based on experimental data.The study groups was formed with two residents,two interns and one tutor in each team.Self-made pressure regulators and lumbar puncture simulations were employed in the experiment.The numbers of drops were counted separately under the pressure of 80 mmH2O,180 mmH2O and 300 mmH2O for both No.7 and No.9 needles.The date showed that The numbers of drops of No.9 needle at pressures of 300 mmH2O,180 mmH2O,80 mmH2O were 120,84,and 34 drops per minute each,those data of No.7 needle were 30,20,10 drops drops/minute at the same pressure.There is a linear correlation between the cerebrospinal fluid drops and pressure,the numbers of drops of No.9 are almost 4 times as those of No.7,which is consistent with Poiseuille’s law.As we know,normally 40-50 drops/minute corresponds to approximately 90-110 mmH2O(No.9).This finding might provide some certain guidances to clinical practice,although it was only a preliminary study which needs further verification.

关 键 词：问题式学习 脑脊液 滴数 腰椎穿刺 压力 

分 类 号：G642[文化科学—高等教育学]