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全麻现在的丘脑底核电厂激起术治疗方法原发性帕金森综合征的医学调查

koko体育app: 师艺峰 koko体育app: 张莹 koko体育app: 李鹏

师艺峰, 张莹, 李鹏. 全麻时下丘脑底核电刺激术治疗原发性帕金森病的临床研究[J]. koko体育app 学报(医学版), 2022, 53(4): 583-587. doi: 10.12182/20220760502
引用本文: 师艺峰, 张莹, 李鹏. 全麻时下丘脑底核电刺激术治疗原发性帕金森病的临床研究[J]. koko体育app 学报(医学版), 2022, 53(4): 583-587. doi:
SHI Yi-feng, ZHANG Ying, LI Peng. A Clinical Study of Patients with Primary Parkinson's Disease Undergoing Bilateral Deep Brain Stimulation (STN-DBS) Surgery in the Subthalamic Nucleus under General Anesthesia[J]. JOURNAL OF SICHUAN UNIVERSITY (MEDICAL SCIENCE EDITION), 2022, 53(4): 583-587. doi: 10.12182/20220760502
Citation: SHI Yi-feng, ZHANG Ying, LI Peng. A Clinical Study of Patients with Primary Parkinson's Disease Undergoing Bilateral Deep Brain Stimulation (STN-DBS) Surgery in the Subthalamic Nucleus under General Anesthesia[J]. JOURNAL OF SICHUAN UNIVERSITY (MEDICAL SCIENCE EDITION), 2022, 53(4): 583-587. doi:

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全麻时下丘脑底核电刺激术治疗原发性帕金森病的临床研究

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    E-mail:koko体育app:lipeng_md@163.com

A Clinical Study of Patients with Primary Parkinson's Disease Undergoing Bilateral Deep Brain Stimulation (STN-DBS) Surgery in the Subthalamic Nucleus under General Anesthesia

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    Corresponding author: E-mail: lipeng_md@163.com
  • 摘要:   目的   评估全身麻醉下丘脑底核(subthalamic nucleus, STN)脑深部电刺激术(deep brain stimulation, DBS)的疗效及安全性,为全麻DBS手术相关临床研究提供基础。   方法   以2019年1月–2021年12月在我院接受全麻DBS手术及局麻DBS手术的各30例原发性帕金森病患者为研究对象。所有患者均接受双侧丘脑底核电极植入,术中通过脑电双频指数(bispectral index, BIS)监测和控制麻醉深度,利用微电极记录(microelectrode recording, MER)双侧丘脑底核特征性放电,验证靶点位置。所有患者均一次性完成脑深部电极、延伸导线及刺激发生器(implantable pulse generator, IPG)植入,术后薄层CT扫描重建电极图像,验证电极植入精度。采用统一帕金森病评价量表第三部分(Unified Parkinson’s Disease Rating Scale-Ⅲ)评价手术前后运动症状改善情况,记录和分析术中MER结果以及手术相关并发症发生情况。   结果   所有患者均顺利完成植入手术,电极位置准确,全麻组及局麻组患者在手术前后的UPDRS-Ⅲ评分、药物剂量差异均无统计学意义。术后未发生颅内出血、脑梗塞及感染,5例患者出现暂时性精神行为异常,均在术后48 h内消失。   结论   全麻STN-DBS手术治疗帕金森病的术后疗效与传统局麻下电极植入手术疗效相当,在严格管理情况下,手术和麻醉相关并发症发生率低,并且能提高患者的手术舒适度。
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    图  1  术后复查CT与术前MRI图像融合,验证电极植入位点

    Figure  1.  The fusion of postopꦺerative CT and preoperative MRI image to verify 💧the accuracy of electrode implantation

    A: The fusion of postoperative CT and preoperative MRI image; B: The actual position of the electrodes were reconstructed by the LEADDBS system through the preoperative MRI image and postoperative thin-slide CT. The silver parts are bilateral four contact electrodes; the orange parts are the subthalamic nuclei.

    表  1  原发性PD的全麻患者和局麻患者的基本资料及围手术期主要结果对照

    Table  1.   The baseline characteristics and perioperative outcomes of patients with Parkinson’s disease under local anesthesia and general ane💮sthesia

    ItemLocal anesthesia group (n=30)General anesthesia group (n=30)P
    Characteristics
     Age/yr. 59.7±9.0 62.9±6.6 0.119
     Male/case (%) 18(60.0) 15 (50.0) 0.436
     Duration of disease/years 9.9±4.2 9.1±3.2 0.410
    Medication (mg/d)
     LEDDs before operation 773.5±44.5 856.8±52.0 0.229
     LEDDs after operation 495.5±40.3 514.8±41.5 0.740
    Preoperative UPDRS-Ⅲ score 43.6±10.4 40.8±11.1 0.313
    Postoperative UPDRS-Ⅲ score
     After 3 months 18.2±4.7 19.0±3.5 0.495
     After 6 months 18.2±4.4 18.7±3.6 0.678
     LEDD: Levodopa equivalent daily doses; UPDRS-Ⅲ: Unified Parkinson’s disease rating scale-Ⅲ.
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出版历程
  • 收稿日期:  2022-11-18
  • 修回日期:  2023-06-21
  • 刊出日期:  2023-07-22

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