全麻下机器人辅助STN-DBS治疗高龄帕金森病的经验分享  

Robot-assisted deep brain stimulation under general anesthesia for elderly patients with Parkinson's disease

作　　者：孙卫进 王澍 关宇光[1,2,3] 赵萌 王雄飞[1] 潘军红 唐重阳[1] 马皓伟 程子章 张小英 腾鹏飞[5] 栾国明 SUN Wei-jin;WANG Shu;GUAN Yu-guang(Department of Neurosurgery,Sanbo Brain Hospital,Capital Medical University,Beijing 100093,China)

机构地区：[1]首都医科大学三博脑科医院神经外科,北京100093 [2]北京市临床医学研究癫痫病重点实验室 [3]北京脑重大疾病研究院癫痫研究所 [4]首都医科大学三博脑科医院神经内科,北京100093 [5]首都医科大学三博脑科医院脑磁图,北京100093

出　　处：《临床神经外科杂志》2023年第2期125-129,134,共6页Journal of Clinical Neurosurgery

基　　金：国家重点研发计划项目(2018YFC2000700,2021YFC2401203)。

摘　　要：目的 分析探讨高龄(>80岁)帕金森病(PD)患者全麻下机器人辅助双侧丘脑底核脑深部刺激植入术(STN-DBS)的安全性及有效性。方法 纳入2020年6月—2021年6月于首都医科大学三博脑科医院接受全麻下机器人辅助双侧STN-DBS治疗的3例高龄PD患者,回顾性分析其临床资料、手术过程并随访评估术后6、12个月的临床症状(UPDRS-Ⅲ开、关期评估运动症状、LEDD评估用药情况、H-Y分期评估症状严重程度)、神经心理预后(HAMA评估焦虑情绪、HAMD评估抑郁情绪)、认知预后(WAIS评估智力认知)及生活质量(ADL评估生活质量)。结果 3例高龄PD患者STN-DBS手术顺利,无严重术中或术后并发症,术后靶点验证植入误差均在0.7 mm以内。术后6个月及12个月评估时,运动症状、症状严重程度、焦虑抑郁情绪、生活质量均较前有显著改善,术后用药量显著减少,神经认知功能无显著变化;6个月随访数据与12个月数据基本无显著差异。结论 全麻下机器人辅助STN-DBS对高龄PD患者有较好的临床疗效,手术安全性基本可控,术后患者运动症状、药物减量、神经心理、生活质量均有显著改善且神经认知功能总体无影响。但应同时注意高龄患者一般状况,根据患者个体状况,对高龄PD患者选择进行STN-DBS治疗。Objective To analyze the efficacy and safety of robot-assisted bilateral deep brain stimulation of the subthalamic nucleus(STN-DBS) under general anesthesia in elderly(80 years old) patients with Parkinson's disease(PD).Methods 3 elderly PD patients who underwent robot-assisted bilateral STN-DBS under general anesthesia in Sanbo Brain Hospital,Capital Medical University from June 2020 to June 2021 were collected.Clinical characteristics,surgical procedures,symptom outcomes at 6 and 12 months after the surgery(UPDRS-Ⅲ “on” and “off” score to assess motor symptoms,LEDD to assess medication dose,H-Y stage to assess symptom severity),neuropsychological outcomes(HAMA to assess anxiety,HAMD to assess depression),cognitive outcomes(WAIS to assesses intelligence and cognition),and quality of life(ADL to assess quality of life) were analyzed retrospectively.Results There were no serious intraoperative or postoperative complications,and the implantation deviations were all within 0.7 mm.6 months and 12 months after the surgery,motor symptoms,symptom severity,anxiety,depression,and quality of life were all significantly improved,the postoperative medication dose was significantly reduced,and there was no significant change in neurocognitive function.There was no significant difference between the 6-month and 12-month follow-ups.Conclusions Robot-assisted STN-DBS under general anesthesia has good efficacy and acceptable safety for elderly PD patients.Postoperative motor symptoms,medication dose,neuropsychology,and quality of life all improved significantly.However,the general condition of elderly patients should be given more attention.STN-DBS for them should be performed according to their individual condition.

关 键 词：帕金森病 高龄 脑深部电刺激术 安全性 疗效 

分 类 号：R742.5[医药卫生—神经病学与精神病学]