帕金森病脑深部电刺激术后远程程控与传统门诊程控效果对比研究  

Comparative study on the efficacy of remote programming and conventional programming after deep brain stimulation for Parkinson′s disease

作　　者：任倩薇 高冬梅 王慧敏[2] 张泉 高源 石红梅[3] 张建国[2] 孟凡刚[1,2,4] Ren Qianwei;Gao Dongmei;Wang Huimin;Zhang Quan;Gao Yuan;Shi Hongmei;Zhang Jianguo;Meng Fangang(Beijing Neurosurgical Institute,Capital Medical University,Beijing 100070,China;Neurosurgery Center,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Dongcheng District Center for Disease Control and Prevention,Beijing 100050,China;Chinese Institute for Brain Research,Beijing 102206,China)

机构地区：[1]首都医科大学,北京市神经外科研究所,北京100070 [2]首都医科大学附属北京天坛医院神经外科学中心,北京100070 [3]北京市东城区疾病预防控制中心,北京100050 [4]北京脑科学与类脑研究中心,北京102206

出　　处：《中华神经外科杂志》2023年第7期689-693,共5页Chinese Journal of Neurosurgery

摘　　要：目的对比分析帕金森病(PD)患者脑深部电刺激(DBS)术后应用传统面对面程控与远程程控方式的疗效差异。方法前瞻性纳入2019年4月至2021年12月于首都医科大学附属北京天坛医院神经外科学中心进行DBS手术的30例PD患者。所有患者术后1个月于门诊开机进行首次程控,之后每3个月程控1次,根据不同的程控方式分为远程程控组(15例)与传统门诊程控组(15例)。于术前、开机后6个月对两组患者进行评估。比较两组患者的术前基线资料、术后国际运动障碍学会统一帕金森病运动量表第三部分(MDS-UPDRSⅢ)评分、每日左旋多巴等效剂量(LEDD)、不良反应、治疗相关时间成本和经济成本以及患者和家属的满意度评分。结果两组患者性别、手术年龄、病程、术前MDS-UPDRSⅢ评分(多巴胺能药物未起效状态)、术前LEDD、术前药物改善率的差异均无统计学意义(均P>0.05),两组患者基本具有可比性。开机后6个月,远程程控组与门诊程控组比较,MDS-UPDRSⅢ评分及其改善率、不良反应发生比例、LEDD减少量的差异均无统计学意义(均P>0.05);远程程控组较门诊程控组患者的程控耗时少[M(Q1,Q3)分别为38(27,62)、120(72,216)h,U=25.50,P=0.001]、支出的程控费用少[M(Q1,Q3)分别为900(900,1200)、8000(1800,12500)元,U=11.00,P=0.001]。远程程控组患者开机后6个月对症状控制的总体满意度、家属及护理人员对程控治疗过程的满意度、患者及家属对与程控医生沟通的有效程度评分均高于门诊程控组(均P<0.05)。结论PD患者DBS术后采用远程程控与门诊程控可获得相似的治疗效果,远程程控并未增加不良反应的发生,且节约时间和经济成本,患者满意度更高,值得临床推广应用。Objective To compare the efficacy of conventional face-to-face programming and remote programming after deep brain stimulation(DBS)in patients with Parkinson′s disease(PD).Methods A prospective study was conducted on 30 PD patients who underwent DBS surgery at the Neurosurgery Center of Beijing Tiantan Hospital,Capital Medical University from April 2019 to December 2021.All patients underwent initial turning-on and first programming at the outpatient clinic one month after surgery,and then programmed once every three months.According to different programming methods,they were divided into remote programming group(15 cases)and conventional outpatient programming group(15 cases).The two groups of patients were evaluated before surgery and 6 months after initial programming.The baseline data before surgery,the score of partⅢof the Movement Disorder Society-Unified Parkinson′s Disease Rating Scale(MDS-UPDRSⅢ),the daily levodopa equivalent dose(LEDD),adverse reactions,treatment-related time cost and economic cost,and patient and family satisfaction scores were compared between the two groups.Results There was no significant difference in gender,surgical age,disease course,preoperative MDS-UPDRSⅢscore,LEDD,and preoperative medication improvement rate between the two groups(all P>0.05),and the two groups were comparable.Six months after initial programming,there was no significant difference in MDS-UPDRSⅢscore and motor score improvement rate,incidence of adverse reactions,or LEDD reduction between the remote programming group and the outpatient programming group(all P>0.05).The time spent on programming[M(Q1,Q3)]in the remote programming group was less than that in the outpatient programming group[38(27,62)h vs.120(72,216)h,U=25.50,P=0.001]and the cost[M(Q1,Q3)]was less[900(900,1200)yuan vs.8000(1800,12500)yuan,U=11.00,P=0.001].The overall satisfaction of patients with symptom control at 6 months post initial programming,the satisfaction of family members and carers with the programming process,and the effe

关 键 词：帕金森病 深部脑刺激法 神经调控 远程医疗 

分 类 号：R651[医药卫生—外科学]