3D-Slicer软件结合导航无框架立体定向穿刺在脑干出血治疗的应用及预后因素分析  

Application of 3D-slicer Software combined with navigation frameless stereotactic puncture for brainstem hemorrhage and an analysis on its prognostic factors

作　　者：秦庚 牛光明[2] 刘展[2] 陶胜忠[2] 娄金峰[2] 王在斌 葛爽 QIN Geng;NIU Guangming;LIU Zhan;TAO Shengzhong;LOU Jinfeng;WANG Zaibin;GE Shuang(Graduate School,Zhengzhou University,Zhengzhou 450001,China)

机构地区：[1]郑州大学研究生学院,郑州450001 [2]郑州大学第二附属医院神经外科,郑州450014

出　　处：《实用医学杂志》2022年第11期1323-1327,共5页The Journal of Practical Medicine

基　　金：河南省医学教育研究项目(编号:Wjlx2020086)。

摘　　要：目的 探讨3D-Slicer软件结合导航无框架立体定向穿刺治疗脑干出血的手术疗效及手术预后。方法 回顾性分析2019年1月至2021年6月于我院接受3D-Slicer软件结合导航下无框架立体定向穿刺手术的31例原发性脑干出血患者的临床资料,以手术治疗90 d后的日常生活活动能力(ADL)分级作为预后评价指标,采用单因素及logistic多因素回归分析方法评估影响预后的独立危险因素,绘制ROC曲线判断危险因素的预测价值。结果 单因素分析显示:出血量、血肿分型、PPH评分、合并脑积水、拔管前血肿量为预后的影响因素(P <0.05)。logistic多因素回归分析结果提示出血量(OR=1.297,P=0.043)、新型脑桥出血评分(OR=6.134,P=0.015)、拔管前血肿量(OR=1.561,P=0.019)是影响患者预后的独立危险因素。ROC曲线分析显示手术患者预后不良的出血量阈值为9.00 mL、拔管前血肿量阈值为2.85 m L。结论 3D-Slicer软件结合导航下无框架立体定向穿刺治疗脑干出血预后较好,手术预后与出血量、拔管前血肿量及新型脑桥出血评分相关。Objective To explore the surgical method of 3D-slicer Software combined with guided frameless stereotactic puncture for the treatment of brainstem hemorrhage and the prognosis of patients. Methods The clinical data on 31 patients with primary brainstem hemorrhage who had undergone 3D-slicer combined with navigation and frameless stereotactic puncture in our hospital from January 2019 to June 2021 were retrospectively analyzed. The grading of activity of daily living(ADL)was used as an index for assessing prognosis. Univariate and logistic regression analyses were used to identify independent risk factors affecting prognosis. ROC curves were drawn to measure the predictive value of risk factors. Results Univariate analysis showed that bleeding volume,hematoma type,PPH score,hydrocephalus,and hematoma volume before extubation were the influencing factors of prognosis(P < 0.05). Logistic multivariate regression analysis showed that bleeding volume(OR = 1.297,P =0.043),scores on new types of pontine bleeding(OR = 6.134,P = 0.015),and hematoma volume before extubation(OR = 1.561,P = 0.019)were independent risk factors affecting the prognosis of patients. The ROC curve showed that the bleeding threshold for a poor prognosis was 9.00 m L and the threshold of the residual hematoma before extubation was 2.85 mL. Conclusions The new surgical procedure provides a better prognosis in patients with brainstem hemorrhage. The prognosis is associated with bleeding volume,hematoma volume before extubation,and scores on new types of pontine hemorrhage.

关 键 词：3D-Slicer软件 无框架立体定向 脑干出血 预后因素 

分 类 号：R743.34[医药卫生—神经病学与精神病学]