我院神经外科专科护士培训模式及效果探讨

目的探讨神经外科专科护士培训模式,培养高素质的专科护理人才,提高神经外科病人的抢救及护理质量。方法确定神经外科专科护士认定资格,对从事神经外科护理工作3年以上的护士进行基础理论及技术(包括专科新理论、新技术)、抢救理论及技术以及开颅手术助手等培训。结果护士的专科知识和技能得到拓展和加深,护士的专科业务水平、工作质量和效率显著提高,危重病人抢救成功率显著上升。结论系统的专科知识与技能培训可推动神经外科专科护士的培养进程,加快专科护理队伍的建设,促进专科护理水平和质量的全面提高。     

脑微创手术规划系统的设计与实现

目的介绍脑微创手术规划系统设计及实现的方法.方法采用VC 结合VTK作为软件开发平台,兼顾系统软件的运行效率和开发效率,并应用软件工程的理论与方法,对系统进行设计.结果该系统可以应用于脑肿瘤、脑出血等手术的规划,并可以进一步扩展成计算机辅助手术系统.结论采用本系统可以提高手术规划可靠性,缩短手术规划时间.     

An abrupt reduction in end-tidal carbon-dioxide during neurosurgery is not always due to venous air embolism: a capnograph artefact

Venous air embolism (VAE) is a well recognized complication during neurosurgery. Pre-cordial doppler and trans-esophageal echocardiography are sensitive monitors for the detection of VAE. A sudden, abrupt reduction in the end-tidal carbondioxide (ETCO₂) pressure with associated hypotension during neurosurgery might suggest VAE, when more sensitive monitors are not available. We describe an unusual cause for sudden reduction in ETCO₂ during neurosurgery and discuss the mechanism for such presentation.     

Co-registration of intra-operative brain surface photographs and pre-operative MR images

Purpose

   Brain shift, the change in configuration of the brain after opening the dura mater, is a significant problem for neuronavigation. Brain structures at intra-operative deformed positions must be matched with corresponding structures in the pre-operative 3D planning data. A method to co-register the cortical surface from intra-operative microscope images with pre-operative MRI-segmented data was developed and tested.

Methods

   Automated classification of sulci on MRI-extracted cortical surfaces was tested by comparison with user guided marking of prominent sulci on an intra-operative photography. A variational registration method with a fidelity energy for 3D deformations of the cortical surface in conjunction with a higher-order, linear elastic prior energy was used for the actual registration. The minimization of this energy was performed with a regularized gradient descent scheme using finite elements for spatial discretization. The sulcal classification method was tested on eight different clinical MRI data sets by comparison of the deformed MRI scans with intra-operative photographs of the brain surface.

Results

   User intervention was required for marking sulci on the photographs demonstrating the potential for incorporating an automatic classifier. The actual registration was validated first on an artificial testbed. The complete algorithm for the co-registration of actual clinical MRI data was successful for eight different patients.

Conclusions

   Pre-operative MRI scans can be registered to intra-operative brain surface photographs using a surface-to-surface registration method. This co-registration method has potential applications in neurosurgery, particularly during functional procedures.     

神经外科护理专业实习生学习手册的设计与使用

为提高神经外科临床教学质量,该文介绍了神经外科实习生学习手册的设计与使用方法.该手册为表格式,分为4部分,阶段式学习任务与考核内容解决了神经外科学习内容多而复杂的难题,师生互评表和师生互动平台实现了互动教学和按需教学,实习生档案为教学和科研积累了宝贵的资料.该手册得到了带教教师和实习生的共同肯定,提高了实习生的学习效率.     

A framework for correcting brain retraction based on an eXtended Finite Element Method using a laser range scanner

Background

Brain retraction causes great distortion that limits the accuracy of an image-guided neurosurgery system that uses preoperative images. Therefore, brain retraction correction is an important intraoperative clinical application.

Methods

We used a linear elastic biomechanical model, which deforms based on the eXtended Finite Element Method (XFEM) within a framework for brain retraction correction. In particular, a laser range scanner was introduced to obtain a surface point cloud of the exposed surgical field including retractors inserted into the brain. A brain retraction surface tracking algorithm converted these point clouds into boundary conditions applied to XFEM modeling that drive brain deformation. To test the framework, we performed a brain phantom experiment involving the retraction of tissue. Pairs of the modified Hausdorff distance between Canny edges extracted from model-updated images, pre-retraction, and post-retraction CT images were compared to evaluate the morphological alignment of our framework. Furthermore, the measured displacements of beads embedded in the brain phantom and the predicted ones were compared to evaluate numerical performance.

Results

The modified Hausdorff distance of 19 pairs of images decreased from 1.10 to 0.76 mm. The forecast error of 23 stainless steel beads in the phantom was between 0 and 1.73 mm (mean 1.19 mm). The correction accuracy varied between 52.8 and 100 % (mean 81.4 %).

Conclusions

The results demonstrate that the brain retraction compensation can be incorporated intraoperatively into the model-updating process in image-guided neurosurgery systems.     

护理专业小组在我院神经外科实施及其效果

目的:探讨神经外科护理专业小组对病区护理质量的影响。方法:该院神经外科分脑血管、脑肿瘤、脑外伤、脑功能康复等4个护理专业小组,并界定各小组的职责和任务。指定专业组长为学科带头人,带领组员开展专业小组活动,以解决本专业临床问题。结果:与实施前比较,实施后病区各项护理质量有所提高(P0.05,P0.01),2007年和2008年该病区连续荣获医院护理质量优秀奖和护理创新成果奖。结论:通过小组活动,调动了护士的主观能动性,提高了组长的整体水平,促进了临床护理质量的改善。     

神经外科手术患者术后早期下床活动的影响因素分析

目的调查神经外科手术患者术后早期下床活动情况,并分析相关影响因素。方法采用分层多级抽样法选取2018年1—5月北京某三级甲等医院神经外科收治的220例行神经外科手术治疗患者,采取自制调查表调查其术后早期下床活动情况,依据是否早期下床活动分为早期下床活动组与未早期下床活动组,比较两组患者临床资料(性别、年龄、经济收入、居住地、婚姻状况、术中失血量、手术类型、疾病种类、携带监护仪、绷带拆除、疼痛、负性情绪、留置尿管、肌力问题、引流管、头晕与呕吐等),并采用Logistic回归分析探讨早期下床活动的影响因素。结果220例患者中,120例(54.55%)患者术后未执行早期下床活动,100例(45.45%)患者执行术后早期下床活动。单因素分析显示,两组患者术中失血量、手术类型、携带监护仪、未拆绷带、留置尿管、肌力问题、引流管、头晕与呕吐比较差异有统计学意义(P<0.05);Logistic回归分析显示,手术类型、未拆绷带、留置尿管、肌力问题、引流管、头晕与呕吐是神经外科手术患者术后早期下床活动的独立影响因素(P<0.05)。结论神经外科手术患者术后早期下床活动执行情况不理想,急诊手术、未拆绷带、留置尿管、存在肌力问题、有引流管、发生头晕与呕吐为影响患者开展早期下床活动的主要独立危险因素,临床护理人员可针对危险因素予以合理干预,以促进患者早期下床,改善预后。     

神经外科患者规范化身体约束管理的循证护理实践

目的 制定神经外科患者规范化身体约束策略并应用于我院神经外科,以规范身体约束策略,提高身体约束护理质量。方法 遵循JBI临床证据实践应用模式,包括证据应用前基线审查、证据应用实践变革及证据应用后效果再审查3个阶段。将最佳证据转化为12条审查指标,应用于神经外科病房。比较证据应用前后患者身体约束率、非计划性拔管率、患者身体约束体验、护士对患者身体约束知信行水平及最佳证据执行率。结果 证据应用后,神经外科患者身体约束率从证据应用前的7.69%下降至2.91%;证据应用前后患者非计划性拔管发生率比较差异无统计学意义（P>0.05）;证据应用后患者约束体验优于证据应用前,差异有统计学意义（P<0.05）;证据应用后神经外科护士对患者身体约束知信行水平高于证据应用前（P<0.05）。12项审查标准执行情况,除审查指标10证据应用前后差异无统计学意义（P>0.05）外,其余各项审查标准证据应用后执行情况均优于证据应用前（P<0.05）。结论 基于最佳证据的规范化身体约束管理策略应用于神经外科患者后,可降低患者身体约束率,同时不增加患者非计划性拔管发生,改善患者约束体验,提高护士对患者身体约束知识信念行为水平,从而改善患者结局,提高护理质量。     

Perspectives on postgenome medicine: Gene therapy for brain tumors

Recent development of therapeutic modalities in neurosurgery has brought about dramatic improvement for prognosis of brain tumors. Nevertheless, malignant glioma is one of the most formidable neoplasms in humans. According to a report by the Committee of Brain Tumor Registry of Japan, five-year relative survival rate of malignant gliomas is less than 10%. Malignant gliomas grow aggressively infiltrating into the surrounding normal brain tissue. So that total surgical resection is impossible. The tumors respond to radiation and chemotherapy, however, the efficiency has sustained transiently. The advert of new strategies for the treatment of malignant gliomas has long been awaited. We have developed a cytokine gene therapy for malignant glioma since about 10 years ago. Here, we introduce both suicide gene therapies and immune gene therapies including our case(IFN-beta gene therapy).