中国现代神经疾病杂志 ›› 2020, Vol. 20 ›› Issue (12): 1057-1065. doi: 10.3969/j.issn.1672-6731.2020.12.006

• 功能神经外科 • 上一篇    下一篇

2 不同麻醉方式下帕金森病脑深部电刺激术疗效对比分析

王澍1, 赵萌1, 王军2, 王雄飞1, 潘军红1, 刘长青1, 刘钊1, 张春生1, 张小英3, 韩一仙3, 栾国明1,4, 关宇光1,4   

  1. 1 100093 北京, 首都医科大学三博脑科医院神经外科;
    2 110001 沈阳, 中国医科大学附属第一医院神经外科;
    3 100093 北京, 首都医科大学三博脑科医院神经内科;
    4 100093 癫痫病临床医学研究北京市重点实验室 北京脑重大疾病研究院癫痫研究所
  • 收稿日期:2020-12-17 出版日期:2020-12-25 发布日期:2020-12-31
  • 通讯作者: 关宇光,Email:guanyg2020@ccmu.edu.cn;栾国明,Email:luangm@ccmu.edu.cn
  • 基金资助:

    国家重点研发计划项目（项目编号：2016YFC0105904）

Long-term effects of deep brain stimulation for Parkinson's disease under local or general anesthesia

WANG Shu1, ZHAO Meng1, WANG Jun2, WANG Xiong-fei1, PAN Jun-hong1, LIU Chang-qing1, LIU Zhao1, ZHANG Chun-sheng1, ZHANG Xiao-ying3, HAN Yi-xian3, LUAN Guo-ming1,4, GUAN Yu-guang1,4   

  1. 1 Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China;
    2 Department of Neurosurgery, the First Hospital of China Medical University, Shenyang 110001, Liaoning, China;
    3 Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China;
    4 Beijing Key Laboratory of Epilepsy;Epilepsy Institute of Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100093, China
  • Received:2020-12-17 Online:2020-12-25 Published:2020-12-31
  • Supported by:

    This study was supported by the National Key Research and Development Program of China (No. 2016YFC0105904).

RichHTML

PDF

摘要：

目的 对比分析局部麻醉与全身麻醉下丘脑底核脑深部电刺激术（STN-DBS）治疗帕金森病的疗效。方法 纳入2015年1月至2018年1月于局部麻醉（22例）或者全身麻醉（18例）下行双侧STN-DBS手术的原发性帕金森病患者共40例，采用统一帕金森病评价量表第三部分（UPDRS-Ⅲ）、Hoehn-Yahr分期、日常生活活动能力量表（ADL）、韦氏成人智力量表（WAIS）和韦氏记忆量表（WMS）、汉密尔顿抑郁量表（HAMD）-17和汉密尔顿焦虑量表（HAMA）-14评价手术前后运动症状、日常生活活动能力、认知功能和记忆力、抑郁和焦虑情绪。结果 全身麻醉组第2根电极靶点偏移低于局部麻醉组[（0.98±0.39）mm对（1.21±0.35）mm；t=-2.041，P=0.048]，第1根电极靶点偏移组间差异无统计学意义[（0.96±0.29）mm对（1.01±0.35）mm；t=-0.496，P=0.623]。与手术前相比，术后6、12和24个月随访时全身麻醉组和局部麻醉组"开"期和"关"期UPDRS-Ⅲ评分（均P=0.001）、Hoehn-Yahr分期（均P=0.001）均明显降低，ADL评分增加（均P=0.001）；但两组各项量表评分比较差异无统计学意义（均P>0.05）。术后1 d，局部麻醉组HAMA-14评分高于入院时（P=0.027）、全身麻醉组HAMD-17评分（P=0.008）和HAMA-14评分（P=0.001）低于术前1 d；术后6、12和24个月随访时两组HAMD-17评分（均P=0.001）和HAMA-14评分（均P=0.001）分别低于入院时、术前1 d和术后1 d，且全身麻醉组HAMD-17评分低于局部麻醉组（P=0.048）。结论 局部麻醉和全身麻醉下STN-DBS均可显著改善帕金森病患者的运动症状、日常生活活动能力、焦虑和抑郁情绪，且不影响认知功能和记忆力，但应注意围手术期不同麻醉方式情绪波动的相关特点，并根据患者具体情况和适应证综合选择麻醉方式。

关键词: 帕金森病, 深部脑刺激法, 丘脑底核, 麻醉, 全身, 麻醉, 局部, 运动障碍, 认知障碍, 焦虑, 抑郁

Abstract:

Objective To compare the efficacy of local anesthesia and general anesthesia of subthalamic nucleus deep brain stimulation (STN-DBS) for Parkinson's disease (PD). Methods Forty PD patients who underwent bilateral STN-DBS from January 2015 to January 2018 were retrospectively analyzed. Twenty-two patients underwent local anesthesia and 18 patients underwent general anesthesia. Pre- and post-operative Unified Parkinson's Disease Rating Scale-Ⅲ (UPDRS-Ⅲ), Hoehn-Yahr, Activities of Daily Living (ADL), Wechsler Adult Intelligence Scale (WAIS), Wechsler Memory Scale (WMS), Hamilton Depression Rating Scale (HAMD)-17 and Hamilton Anxiety Rating Scale (HAMA)-14 were used to assess the motor symptoms, daily living function, cognitive function, memory, anxiety and depression. Results The target deviation of the second electrode in general anesthesia group was lower than that in local anesthesia group[(0.98±0.39) mm vs. (1.21±0.35) mm; t=-2.041, P=0.048], the target deviation of the first electrode was not statistically significant[(0.96±0.29) mm vs. (1.01±0.35) mm; t=-0.496, P=0.623]. At 6, 12, and 24 months after surgery, the "on" and "off" UPDRS-Ⅲ scores (P=0.001, for all) and Hoehn-Yahr (P=0.001, for all) in the general anesthesia group and the local anesthesia group were all significantly decreased compared with baseline, ADL score significanly increased (P=0.001, for all). There were no significant differences in "on" and "off" UPDRS-Ⅲ, Hoehn-Yahr, ADL, WAIS and WMS scores between 2 groups (P>0.05, for all). One day after surgery, the HAMA-14 in the local anesthesia group was higher than baseline (P=0.027), in the general anesthesia group, HAMD-17 (P=0.008) and HAMA-14 (P=0.001) scores were lower than 1 d before surgery. The HAMD-17 (P=0.001, for all) and HAMA-14 (P=0.001, for all) of 2 groups at 6, 12 and 24 months after surgery were all lower than baseline, 1 d before and 1 d after surgery. HAMD-17 score in the general anesthesia group was lower than the local anesthesia group (P=0.048). Conclusions Both general anesthesia and local anesthesia STN-DBS can significantly improve PD motor symptoms and quality of life, as well as relieve the depression and anxiety symptoms, without affecting cognitive function and memory. Attention should be paid to mood fluctuations in using different anesthesia during the perioperative period. Choice of anesthesia method should be based on the patient's condition and indications.

Key words: Parkinson disease, Deep brain stimulation, Subthalamic nucleus, Anesthesia, general, Anesthesia, local, Motor disorders, Cognition disorders, Anxiety, Depression

版权所有 © 《中国现代神经疾病杂志》编辑部
地址：天津市津南区吉兆路6号　
邮编：300350　
电话：022-59065611　
E-mail：xdsjjbzz@263.net.cn
技术支持：北京玛格泰克科技发展有限公司