帕金森病患者脑深部电刺激术后神经精神功能障碍发生率及其影响因素分析:一项前瞻性队列研究  

Incidence and Risk Factors of Postoperative Neuropsychiatric Dysfunctions After Deep Brain Stimulation Surgery in Patients with Parkinson's Disease:A Prospective Cohort Study

作　　者：谢思宁[1] 蒋忱冠 李享佳卉 韩如泉[1] 杨舟 李秉心 石林[2,4] XIE Sining;JIANG Chenguan;LI Xiangjiahui;HAN Ruquan;YANG Zhou;LI Bingxin;SHI Lin(Department of Anesthesiology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Basic Medicine,Capital Medical University,Beijing 100069,China;Functional Neurosurgery Laboratory,Beijing Neurosurgical Institute,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院麻醉科,北京100070 [2]首都医科大学附属北京天坛医院神经外科,北京100070 [3]首都医科大学基础医学院,北京100069 [4]北京市神经外科研究所,北京100070

出　　处：《协和医学杂志》2025年第2期300-306,共7页Medical Journal of Peking Union Medical College Hospital

基　　金：国家自然科学基金面上项目(82471490);北京市自然科学基金杰出青年科学基金项目(JQ23038);贝恩麻醉科学研究项目(bnmr-2023-009);北京市医院管理中心扬帆计划医工结合培育项目(YGLX202321)。

摘　　要：目的探究采用脑深部电刺激(deep brain stimulation,DBS)治疗的帕金森病(Parkinson's disease,PD)患者术后神经精神功能障碍(postoperative neuropsychic dysfunction,PND)发生情况,并分析其影响因素。方法前瞻性招募2020年1月—2022年12月首都医科大学附属北京天坛医院门诊就诊的PD患者为研究对象。所有患者均拟行以双侧丘脑底核(subthalamic nucleus,STN)为靶点的DBS手术。收集患者围术期临床资料,并结合蒙特利尔认知评估量表、简易精神状态检查量表、汉密尔顿抑郁与焦虑量表、3 min意识模糊评估量表判定患者术后3 d内是否出现PND(结局指标)。采用多因素Logistic回归法分析PND的影响因素。结果共招募216例PD患者。DBS术后3 d内出现PND 77例(35.6%),其中包括出现抑郁或其程度加重24例(31.2%),出现焦虑或其程度加重16例(20.8%),认知功能评级下降13例(16.9%),出现谵妄表现24例(31.2%)。单因素分析结果显示,硬脑膜开放方式、硬脑膜开放时间、术中统一帕金森病评分量表第三部分(unified Parkinson's disease rating scale-Ⅲ,UPDRS-Ⅲ)评分改善率、术后颅内气体体积在PND患者与非PND患者之间具有统计学差异(P均<0.05)。多因素Logistic回归分析结果显示,女性(OR=2.468,95%CI:1.077~5.657,P=0.033)、术后颅内气体体积(OR=1.217,95%CI:1.096~1.351,P<0.001)是PD患者DBS术后发生PND的独立危险因素,而较高的术中UPDRS-Ⅲ评分改善率为其保护性因素(OR=0.894,95%CI:0.863~0.925,P<0.001)。结论DBS术后PD患者具有较高的PND发生率,性别、术后颅内积气量和PD运动症状改善程度可影响PND发生风险,提示针对性别进行个体化管理、提升手术技巧并加强患者神经精神状态监测在优化DBS手术疗效中的重要性。Objective To investigate the incidence of postoperative neuropsychic dysfunction(PND)in Parkinson's disease(PD)patients undergoing deep brain stimulation(DBS)and to analyze its influencing factors.Methods A prospective study was conducted between January 2020 and December 2022,recruiting PD patients from the Functional Neurosurgery Outpatient Clinic of Beijing Tiantan Hospital,Capital Medical University.All patients were scheduled to undergo bilateral subthalamic nucleus(STN)⁃DBS surgery.Perioperative clinical data were collected,and PND(outcome measure)within 3 days postopera⁃tively was assessed using the Montreal cognitive assessment(MoCA),mini⁃mental state examination(MMSE),Hamilton depression and anxiety scales,and 3⁃minute diagnostic interview for confusion assess⁃ment method(3D⁃CAM).Multivariate Logistic regression was used to analyze the influencing factors of PND.Results A total of 216 PD patients were enrolled.Within 3 days after DBS surgery,77 patients(35.6%)developed PND,including 24 cases(31.2%)of depression or worsening depression,16 cases(20.8%)of anxiety or worsening anxiety,13 cases(16.9%)of cognitive decline,and 24 cases(31.2%)of deliri⁃um.Univariate analysis revealed that dural opening method,dural opening time,intraoperative improvement rate of the unified Parkinson's disease rating scale⁃Ⅲ(UPDRS⁃Ⅲ)score,and postoperative intracranial air volume were significantly different between PND and non⁃PND patients(all P<0.05).Multivariate Logistic regression analysis showed that female sex(OR=2.468,95%CI:1.077-5.657,P=0.033)and postop⁃erative intracranial air volume(OR=1.217,95%CI:1.096-1.351,P<0.001)were independent risk factors for PND,while a higher intraoperative UPDRS⁃Ⅲimprovement rate was a protective factor(OR=0.894,95%CI:0.863-0.925,P<0.001).Conclusions PD patients have a high incidence of PND after DBS surgery.Sex,postoperative intracranial air volume,and the degree of improvement in PD motor symptoms can influence the risk of PND.These findings highlight the impo

关 键 词：帕金森病 脑深部电刺激 术后神经精神功能障碍 

分 类 号：R741[医药卫生—神经病学与精神病学] R749[医药卫生—临床医学]