3D打印辅助微创精准穿刺治疗脑干出血的临床研究  

Clinical study of 3D printing assisted minimally invasive precision puncture in the treatment of brainstem hemorrhage

作　　者：夏磊[1] 尚进[1] 朱晓峰 王成云[1] 肖峰[1] 陈冰[1] 陈泉[1] 韩秋 XIA Lei;SHANG Jin;ZHU Xiaofeng;WANG Chengyun;XIAO Feng;CHEN Bing;CHEN Quan;HAN Qiu(The Affiliated Huaian NO.1 People’s Hospital of Nanjing Medical University,Huai’an 223000,China)

机构地区：[1]南京医科大学附属淮安第一医院,江苏淮安223000

出　　处：《中国实用神经疾病杂志》2022年第9期1063-1067,共5页Chinese Journal of Practical Nervous Diseases

基　　金：2020年度淮安市卫生健康科研立项项目(编号:HAWJ202001)。

摘　　要：目的评估3D打印导板引导下微创穿刺引流术(MIPD)对脑干出血的治疗效果。方法纳入2018-05—2021-06南京医科大学附属淮安第一医院收治的采用3D打印导板引导下MIPD治疗的脑干出血患者30例为治疗组。倾向性评分与治疗组相匹配的行保守治疗的30例脑干出血患者作为对照组。比较2组患者入院时、治疗后的血肿体积以及医院获得性肺炎(HAP)、再出血的发生率、院内病死率、住院时间、出院30 d的mRS评分。结果治疗组术后血肿体积(8.29±2.47)mL与对照组(13.67±5.08)mL及术前(12.51±4.40)mL相比均明显降低(P<0.01)。治疗组的HAP发生率(13.3%)和院内病死率(6.9%)低于对照组的50%和30%,差异均有统计学意义(P<0.05)。2组再出血发生率比较无明显差异(P>0.05)。治疗组住院时间(24.4±4.38)d,显著低于对照组的(28.6±4.63)d(P<0.001)。出院30 d时治疗组mRS评分1、2分例数(14例)明显高于对照组(5例)(P=0.037)。结论3D打印辅助微创精准穿刺引流治疗脑干出血疗效优于保守治疗,能够及早解除血肿压迫,减轻神经功能缺损,降低HAP发生率,缩短住院时间,减少致死及致残率。Objective To evaluate the therapeutic effect of minimally invasive puncture and drainage guid⁃ed by 3D printing guide on brainstem hemorrhage.Methods From May 2018 to June 2021,30 patients with brainstem hemorrhage treated with mipd guided by 3D printing guide were treated in our hospital as the treatment cohort.30 patients with brainstem hemorrhage who were treated conservatively with propensity score matched with the treatment cohort were used as the control cohort.The hematoma volume at admission and after treatment,the incidence of hospital acquired pneumonia(HAP),rebleeding,in-hospital mortality,length of stay and mRS score of 30 days after discharge were compared between the two group.Results The volume of hematoma after operation in the treatment group was significantly lower than that in the control group and before operation(P<0.01).The incidence of HAP(13.3%)and in-hospital mortality(6.9%)in the treatment cohort were lower than 50%and 30%in the control cohort(P<0.05).There was no significant difference in the incidence of rebleeding between the two groups(P>0.05).The length of stay in the treatment cohort(24.4±4.38)was significantly lower than that in the control cohort(28.6±4.63)(P<0.001).At 30 days after discharge,the proportion of Mrs score 1 and 2 in the treatment group was significantly higher than that in the control group(P=0.037).Conclusion The curative effect of minimally invasive precise puncture and drainage under the guidance of 3D printing guide in the treatment of brainstem hemorrhage is better than conservative treatment.It can relieve the compression of hematoma as soon as possible,reduce the neurological deficit,reduce the incidence of HAP,shorten the length of hospital stay,and reduce the mortality and disability rate.

关 键 词：脑干出血 微创穿刺引流术 3D打印 医院获得性肺炎 

分 类 号：R743.34[医药卫生—神经病学与精神病学]