不同麻醉方式在帕金森病病人丘脑底核脑深部电刺激手术中的临床效果

doi:10.3969/j.issn.1003-9198.2023.09.018

摘要/Abstract

摘要： 目的对比分析不同麻醉方式对PD病人丘脑底核(STN)脑深部电刺激(DBS)手术的效果。方法回顾性分析2017年10月至2022年10月期间在南京医科大学第一附属医院进行双侧STN-DBS手术的PD病人148例,其中全麻组81例,局麻组67例。记录2组术前计划框架靶点坐标和术后实际植入靶点坐标,计算电极植入误差并评价准确性。同时,对2组的术前基线特征和术后统一帕金森病评定量表运动评分(UPDRS-Ⅲ)的改善率进行分析。结果全麻组计划框架靶点和实际植入靶点在前后距离(y)、内外侧距离(x)、垂直距离(z)的差异均无统计学意义。局麻组两侧电极的计划框架靶点和实际植入靶点的y差异具有统计学意义,实际植入电极更偏向后方,而x和z差异无统计学意义。全麻组的手术时长显著小于局麻组;局麻组有3例病人出现无症状脑出血,全麻组未出现;与手术前相比,术后1个月2组的UPDRS-Ⅲ改善率无明显差异。结论全麻下PD病人行STN-DBS手术的与效果局麻方式相当,但手术时间更短,安全性更高,因此全麻下PD病人行STN-DBS手术值得推广。

关键词: 帕金森病, 脑深部电刺激, 全身麻醉, 丘脑底核, 微电极记录

Abstract: Objective To compare the effects of different anesthetic modalities on deep brain stimulation (DBS) in the subthalamic nucleus (STN) in the patients with Parkinson's disease (PD). Methods The clinical data of 158 patients with PD who underwent bilateral STN-DBS surgery at the First Affiliated Hospital of Nanjing Medical University between October 2017 and October 2022 were retrospectively analyzed. Among them, 81 cases received general anesthesia (general anesthesia group) and 67 cases received local anesthesia (local anesthesia group). The coordinates of the intended preoperative frame targets and the actual postoperative implanted targets in both groups were recorded. The preoperative baseline characteristics and the improvement rate of postoperative Unified Parkinson's Disease Rating Scale motor score (UPDRS-Ⅲ) were also compared between the two groups. Results The anterior-posterior distance (y), medial-lateral distance (x) and vertical distance (z) showed no significant differences between intended preoperative frame targets and the actual postoperative implanted targets in the general anesthesia group. Y showed significant difference between the electrodes on both sides in the local anesthesia group, and the actual implanted electrodes were more posteriorly oriented. The operation time was significantly less in the general anesthesia group than that in the local anesthesia group.Three patients experienced asymptomatic cerebral haemorrhage in the local anesthesia group.The improvement rate of UPDRS-Ⅲ 1 month after operation showed no significant difference between the two groups. Conclusions DBS surgery for PD under general anaesthesia can achieve the same results as local anaesthesia surgery, but with a shorter operative time and better safety, which is worth promoting.

Key words: Parkinson's disease, deep brain electrical stimulation, general anaesthesia, subthalamic nucleus, microelectrode recording

中图分类号:

R 749.1

吕坤, 曹纹平, 王宇航, 赵春生, 曹胜武. 不同麻醉方式在帕金森病病人丘脑底核脑深部电刺激手术中的临床效果[J]. 实用老年医学, 2023, 37(9): 938-942.

LYU Kun, CAO Wen-ping, WANG Yu-hang, ZHAO Chun-sheng, CAO Sheng-wu. Effects of different anesthetic modalities on deep brain stimulation in subthalamic nucleus for Parkinson's disease[J]. Practical Geriatrics, 2023, 37(9): 938-942.

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