摘要：

目的 对帕金森病患者全身麻醉与局部麻醉下丘脑底核脑深部电刺激术（STN-DBS）中丘脑底核电生理监测结果进行对比分析。方法 以2017年1月至2019年10月确诊的44例原发性帕金森病患者为研究对象，于全身麻醉（22例）或局部麻醉（22例）下行双侧STN-DBS；全身麻醉组于脑电双频指数（BIS）监测下植入电极，术中定位丘脑底核并微电极记录双侧丘脑底核电生理信号长度，术后复查MRI或CT与术中定位对比，计算电极靶点径向误差。结果 全身麻醉组和局部麻醉组均记录到丘脑底核典型放电并定位其感觉运动功能亚区。全身麻醉组与局部麻醉组双侧丘脑底核电生理信号长度[左侧（5.46±0.98）mm对（5.30±0.91）mm，t=0.561，P=0.578；右侧（5.21±0.85）mm对（5.21±1.21）mm，t=0.000，P=1.000]、统一帕金森病评价量表第三部分（UPDRS-Ⅲ）评分（16.37±0.83对16.20±0.98；t=0.621，P=0.538）、不良反应发生率[68.18%（15/22）对72.73%（16/22）；χ²=0.109，P=0.741]，以及术后复查双侧电极靶点径向误差[左侧（1.24±0.56）mm对（1.18±0.52）mm；t=0.337，P=0.738；右侧（1.10±0.45）mm对（1.05±0.53）mm；t=0.368，P=0.715]差异均无统计学意义。结论 无论是全身麻醉还是局部麻醉下STN-DBS对术中丘脑底核的电生理信号均无明显影响，施行全身麻醉的患者术中根据脑电双频指数调整麻醉深度，当BIS ≥ 70时微电极可记录到清晰的丘脑底核电生理信号并精准植入电极。

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, 电生理学, 监测, 手术中

Abstract:

Objective To compare the electrophysiological results of subthalamic nucleus deep brain stimulation (STN-DBS) for the treatment of Parkinson's disease (PD) under local or general anesthesia. Methods The data of 44 patients with PD who underwent STN-DBS surgery were retrospectively analyzed from January 2017 to October 2019. Among them, 22 cases were performed under general anesthesia with bispectral index (BIS), and the other 22 were implanted under local anesthesia. Microelectrode recording (MER) was used in 2 groups to locate the STN during operation and the electrophysiological signal length and the radial error of the electrode target after the MRI or CT reexaimined were analyzed and compared between 2 groups. Results Both general anesthesia group and local anesthesia group recorded typical discharges of the STN and located its sensorimotor function sub-regions. When the BIS value of patients in general anesthesia group was adjusted to 70 or above, their STN electrophysiological conditions were consistent with those under local anesthesia. There was no statistically significant difference in the electrophysiological length of bilateral STN between general anesthesia group and local anesthesia group[left (5.46±0.98) mm vs. (5.30±0.91) mm; t=0.561, P=0.578; right (5.21±0.85) mm vs. (5.21±1.21) mm; t=0.000, P=1.000]. There was no statistically significant difference in Unified Parkinson's Disease Rating Scale-Ⅲ (UPDRS-Ⅲ) score (16.37±0.83 vs. 16.20±0.98; t=0.621, P=0.538) and incidence of adverse reactions[68.18% (15/22) vs. 72.73% (16/22); χ²=0.109, P=0.741] between 2 groups. After reexamination of MRI or CT and fusion with intraoperative MRI, there was no statistically significant difference in the radial error of the bilateral electrode targets between 2 groups[left (1.24±0.56) mm vs. (1.18±0.52) mm; t=0.337, P=0.738; right (1.10±0.45) mm vs. (1.05±0.53) mm, t=0.368, P=0.715]. Conclusions The typical discharge of STN could be recorded in both local and general anesthesia STN-DBS groups, and the sensory-motor area of STN could also be accurately indentified through its discharge. There is no significant difference in the length of STN electrophysiological signal and electrode error between 2 groups. The results showed that the precise implantation of intracranial electrodes in STN-DBS surgery could be performed under local or general anesthesia.

Key words: Parkinson disease, Deep brain stimulation, Subthalamic nucleus, Anesthesia, general, Anesthesia, local, Electrophysiology, Monitoring, intraoperative