麻醉方式和微电极记录对脑深部电刺激术治疗帕金森病效果的影响  

Effects of anesthesia method and microelectrode recording on outcomes of deep brain stimulation for patients with Parkinson's disease

作　　者：王宇航 吕坤 鄂语乾 曹胜武 赵春生 曹纹平 WANG Yu-hang;LÜKun;E Yu-qian;CAO Sheng-wu;ZHAO Chun-sheng;CAO Wen-ping(Department of Neurosurgery,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]南京医科大学第一附属医院神经外科,南京210000

出　　处：《中国临床神经外科杂志》2024年第6期321-326,共6页Chinese Journal of Clinical Neurosurgery

基　　金：江苏省科教能力提升工程(ZDXK202225)。

摘　　要：目的探讨麻醉方式和微电极记录(MER)对脑深部电刺激术(DBS)治疗帕金森病(PD)效果的影响。方法回顾性分析2016年1月至2020年12月行双侧丘脑底核(STN)-DBS治疗的112例PD的临床资料。根据麻醉方式和使用MER情况分为4组:局部麻醉(LA)+MER组(n=22),LA+非MER组(n=25),全身麻醉(GA)+MER组(n=34),GA+非MER组(n=31)。记录术后并发症情况;术后复查CT计算靶点和实际电极尖端坐标,并采用欧氏距离(ED)评估电极植入精度;术后1个月开机,采用UP-DRS-Ⅲ评分评估疗效。结果术后1个月UPDRS-Ⅲ评分改善率:LA+MER组[(50.04±7.20)%]、GA+MER组[(51.80±8.04)%]和GA+非MER组[(52.23±7.92)%]均明显高于LA+非MER组[(40.37±9.76)%;P<0.05]。颅内积气:LA+MER组[(8.17±5.38)ml]和LA+非MER组[(10.27±4.22)ml]明显高于GA+MER组[(4.68±1.25)ml;P<0.05]和GA+非MER组[(4.75±1.08)ml;P<0.05]。与其他三组相比,LA+非MER组第一靶点和第二靶点Y轴偏差均明显增大(P<0.05)。结论麻醉方式和MER的选择对STN-DBS治疗PD具有一定的影响。使用MER可纠正GA引起的脑脊液丢失和体位导致的靶点误差,提高植入电极的准确性。Objective To explore the effects of anesthesia method and microelectrode recording(MER)on the outcome of deep brain stimulation(DBS)for patients with Parkinson's disease(PD).Methods The clinical data of 112 PD patients who underwent bilateral subthalamic nucleus(STN)-DBS from January 2016 to December 2020 were retrospectively analyzed.According to the anesthesia method and the use of MER,they were divided into 4 groups:local anesthesia(LA)+MER group(n=22),LA+non-MER group(n=25),general anesthesia(GA)+MER group(n=34),and GA+non-MER group(n=31).The postoperative complications were recorded;the coordinates of the target and the actual electrode tip were calculated by postoperative CT images,and the Euclidean distance(ED)was used to assess the accuracy of electrode implantation;the stimulator was activated 1 month after the surgery,and the UPDRS-Ⅲscore was used to assess the therapeutic effect.Results The improvement rate of UPDRS-Ⅲscore 1 month after the surgery:the LA+MER group[(50.04±7.20)%],the GA+MER group[(51.80±8.04)%],and the GA+non-MER group[(52.23±7.92)%]were significantly higher than the LA+non-MER group[(40.37±9.76)%;P<0.05].Intracranial pneumatosis:the LA+MER group[(8.17±5.38)ml]and the LA+non-MER group[(10.27±4.22)ml]were significantly higher than the GA+MER group[(4.68±1.25)ml;P<0.05]and the GA+non-MER group[(4.75±1.08)ml;P<0.05].Compared with the other three groups,the Y-axis deviations of the first and second targets in the LA+non-MER group were significantly increased(P<0.05).Conclusions The choice of anesthesia method and MER has a certain influence on the outcomes of STN-DBS for PD patients.The use of MER can correct the target errors caused by cerebrospinal fluid loss and body position under GA and improve the accuracy of electrode implantation.

关 键 词：帕金森病 脑深部电刺激术 丘脑底核 微电极记录 麻醉方式 

分 类 号：R742.5[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]