不同麻醉方式下帕金森病脑深部电刺激术疗效对比分析

Long-term effects of deep brain stimulation for Parkinson’s disease under local or general anesthesia

目的对比分析局部麻醉与全身麻醉下丘脑底核脑深部电刺激术(STN-DBS)治疗帕金森病的疗效。方法纳入2015年1月至2018年1月于局部麻醉(22例)或者全身麻醉(18例)下行双侧STN-DBS手术的原发性帕金森病患者共40例,采用统一帕金森病评价量表第三部分(UPDRS-Ⅲ)、Hoehn-Yahr分期、日常生活活动能力量表(ADL)、韦氏成人智力量表(WAIS)和韦氏记忆量表(WMS)、汉密尔顿抑郁量表(HAMD)-17和汉密尔顿焦虑量表(HAMA)-14评价手术前后运动症状、日常生活活动能力、认知功能和记忆力、抑郁和焦虑情绪。结果全身麻醉组第2根电极靶点偏移低于局部麻醉组[(0.98±0.39)mm对(1.21±0.35)mm;t=-2.041,P=0.048],第1根电极靶点偏移组间差异无统计学意义[(0.96±0.29)mm对(1.01±0.35)mm;t=-0.496,P=0.623]。与手术前相比,术后6、12和24个月随访时全身麻醉组和局部麻醉组"开"期和"关"期UPDRS-Ⅲ评分(均P=0.001)、Hoehn-Yahr分期(均P=0.001)均明显降低,ADL评分增加(均P=0.001);但两组各项量表评分比较差异无统计学意义(均P>0.05)。术后1 d,局部麻醉组HAMA-14评分高于入院时(P=0.027)、全身麻醉组HAMD-17评分(P=0.008)和HAMA-14评分(P=0.001)低于术前1 d;术后6、12和24个月随访时两组HAMD-17评分(均P=0.001)和HAMA-14评分(均P=0.001)分别低于入院时、术前1 d和术后1 d,且全身麻醉组HAMD-17评分低于局部麻醉组(P=0.048)。结论局部麻醉和全身麻醉下STN-DBS均可显著改善帕金森病患者的运动症状、日常生活活动能力、焦虑和抑郁情绪,且不影响认知功能和记忆力,但应注意围手术期不同麻醉方式情绪波动的相关特点,并根据患者具体情况和适应证综合选择麻醉方式。

Objective To compare the efficacy of local anesthesia and general anesthesia ofsubthalamic nucleus deep brain stimulation(STN-DBS)for Parkinson’s disease(PD).Methods Forty PD patients who underwent bilateral STN-DBS from January 2015 to January 2018 were retrospectivelyanalyzed.Twenty-two patients underwent local anesthesia and 18 patients underwent general anesthesia.Pre-and post-operative Unified Parkinson’s Disease Rating Scale-Ⅲ(UPDRS-Ⅲ),Hoehn-Yahr,Activitiesof Daily Living(ADL),Wechsler Adult Intelligence Scale(WAIS),Wechsler Memory Scale(WMS),Hamilton Depression Rating Scale(HAMD)-17 and Hamilton Anxiety Rating Scale(HAMA)-14 were usedtRo esaussltesss the motor symptoms,daily living function,cognitive function,memory,anxiety and depression.The target deviation of the second electrode in general anesthesia group was lower than that inlocal anesthesia group[(0.98±0.39)mm vs.(1.21±0.35)mm;t=-2.041,P=0.048],the target deviation ofthe first electrode was not statistically significant[(0.96±0.29)mm vs.(1.01±0.35)mm;t=-0.496,P=0.623].At 6,12,and 24 months after surgery,the"on"and"off"UPDRS-Ⅲscores(P=0.001,for all)and Hoehn-Yahr(P=0.001,for all)in the general anesthesia group and the local anesthesia group were allsignificantly decreased compared with baseline,ADL score significanly increased(P=0.001,for all).There were no significant differences in"on"and"off"UPDRS-Ⅲ,Hoehn-Yahr,ADL,WAIS and WMSscores between 2 groups(P>0.05,for all).One day after surgery,the HAMA-14 in the local anesthesiagroup was higher than baseline(P=0.027),in the general anesthesia group,HAMD-17(P=0.008)andHAMA-14(P=0.001)scores were lower than 1 d before surgery.The HAMD-17(P=0.001,for all)andHAMA-14(P=0.001,for all)of 2 groups at 6,12 and 24 months after surgery were all lower thanbaseline,1 d before and 1 d after surgery.HAMD-17 score in the general anesthesia group was lower thanthe local anesthesia group(P=0.048).ConclusionsBoth general anesthesia and local anesthesia STN-DBS can significantly improve PD motor symptoms and quality of life,as well as relieve the depressionand anxiety symptoms,without affecting cognitive function and memory.Attention should be paid to moodfluctuations in using different anesthesia during the perioperative period.Choice of anesthesia methodshould be based on the patient’s condition and indications.