脊髓穿刺在临床上的应用较为广泛,主要是麻醉领域。脊髓穿刺是临床上一项较为困难的操作,要求医生操作十分精确熟练,因为穿刺一旦发生错误,将会带来十分严重的并发症。临床上每年几乎要进行数百万例的硬膜外麻醉,如何培养年轻医生尽快尽好的掌握这项操作技术,成为人们越来越关注的问题。
脊髓穿刺和很多其他医疗操作一样,无法在人体上进行实践,然而实践操作对于医生的技能培训来说却又是十分关键的。来自爱尔兰国立Limerick大学的研究者们带来了解决这一矛盾的方法,他们利用触感技术和3D可视化制造了脊髓穿刺训练工具,该模拟装置利用计算机图形学和虚拟针管真实地模拟脊髓穿刺,可以使医生无需在活体上实践就能够培训脊髓穿刺麻醉的操作技能。
人体的脊椎有一层不到1〞的凝胶样的保护物质,安全穿刺脊柱是非常困难的,一不小心就很有可能会损坏病人的脊柱或者周围的血管。以前,医生在学习这项技能的时候不得不高度小心,以免损伤病人的脊柱。而现在,据研发者介绍,这项技术可以使年轻医生毫无顾忌的实施操作,训练模拟器的开发是对过去几年广泛应用于医院的脊髓穿刺麻醉教学方法的一项重大突破。Limerick互动设计中心的研究员Erik还介绍说:“过去,许多评估培训医生的方法都是主观的,这个工具则给了培训者一个客观评价学习者的机会。”
此外,模拟训练器还可以用于重塑手术。该模拟器采用先进的“触觉工具包”技术,这种包含了多学科多领域的技术能够准确地再现实时手术中的触觉和感觉。不仅如此,有些患者因担心术后并发症而在脊髓穿刺中不能被完全麻醉,这样的问题也可以因为模拟器的使用而解决。
脊髓穿刺模拟器的特点主要包括:
(1)“触觉模拟器”再现了医生点针插入皮肤的紧张触感;
(2)如果穿刺操作不正确,学员会立即收到视听反馈;
(3)研发者从医生那里收集了广泛的脊柱穿刺的精确触觉反应,使得模拟效果更加逼真;
(4)模拟器结合视觉反馈模式使操作者在穿刺的同时能够看到这一区域的3D画面;
(5)操作者还可以任意设定“测试”或“练习”模式,并且确定最佳的脊髓穿刺点——椎管内;
(6)在“测试”模式下,可以关闭音频和视频引导;
(7)如同真实操作的过程,针管的正确位置由针管内的视线引流液标记。
脊髓穿刺模拟器可能的应用还包括模拟老年病人的穿刺、孕妇的硬膜外穿刺和获得脑脊液活检样品的腰椎穿刺。
目前,这项研究已部分通过发展阶段,并且在匈牙利和爱尔兰已经开始应用于临床。 Spinal Haptic Training Simulator Developed
Performing spinal and epidural injections is a craft perfected with experience, and subject to serious consequences, if mistakes are made. As in many other procedures practicing on live humans is understandably impossible, so researchers from the University of Limerick in Ireland used haptic technology and 3D visualization to create a training tool. Considering the millions of epidurals performed each year, the technology should prepare young physicians to perform them without hesitation.
The BBC reports:
The "haptic simulator" recreates the skin tension felt by the practitioner at the point the needle is inserted.
If the injection is not carried out correctly, the trainee receives immediate audio and visual feedback.
The developers questioned doctors extensively about the precise tactile responses involved in inserting a needle between two vertebrae of the human back.
The result is an advance that incorporates visual feedback - allowing the operator to view a 3-D map of the area while simultaneously positioning the needle.
Trainees can operate in either "trial" or "practise" mode, and safely locate the optimal point for a spinal injection - called the "intrathecal space".
In trial mode, the audio and visual clues can be turned off.
Correct placement of the needle is registered by the sight of fluid draining from the needle, which is what happens during the real procedure.
(张果的博客)
作者: xyz-cn99 时间: 2009-5-27 21:56
脊髓麻醉模拟培训(国外)
A training simulator for the medical procedure of spinal anaesthesia. It was developed by Cork University Hospital, Ireland and Interaction Design Centre, Ireland作者: jh1y 时间: 2009-6-3 21:15
确实是个好东西,由于不好在病人身上练技术,曾有尝试在尸体上穿刺的,现在模拟器出来了解决了这一问题,如果能够把各个部位的神经阻滞的操作都模拟出来就更好了。