深部脑刺激戒断阿片类药物精神依赖1例临床报道(附3个月随访结果)

The clinical report of alleviating drug psychological dependence by deep brain stimulation(initial clinical results after three months follow-up)

目的在立体定向射频毁损手术的研究基础上,进行了1例深部脑刺激(deepbrainstimulation,DBS)戒断阿片类药物精神依赖手术,探讨一种既能起到有效治疗作用,而又减少副损伤的外科治疗方法。方法药物依赖患者,男性,24岁,吸食海洛因等多种毒品成瘾5年,反复戒毒5次无效。在阿片脱毒术脱毒后,行双侧伏隔核DBS电极植入术,立体定向MRI定位,植入Medtronic3387刺激电极及脉冲发生器。术后定期进行疗效随访,以及副作用、心理学量表和症状量表等评估。结果患者术后即停止吸毒,通过3个月的临床观察,至今无复吸现象。临床证实该方法较射频毁损方法微创、副反应小,心理学量表(WMS、WEIS-RC和MMPI)评估未发现有记忆、智力和人格等方面影响。术后患者饮食较术前明显好转,体重增加,吸烟量明显减少;症状自评量表(SCL-90、SAS和SDS)评估提示多因素均有明显改善。结论应用DBS外科方法戒断阿片类药物精神依赖,取得短期满意疗效。

Objective On the basis of former clinical studies in alleviating opiate drug psychological dependence by ablating the nucleus accumbens (NAc) with stereotactic surgery,the first case of NAc deep brain stimulation (DBS) surgery was reported,to investigate a new method to minimize the injury.Methods A 24-year-old male patient with a history of opiate drug-taking history more than five years,and his five previous detoxifications were not effective.After anesthesia assisted opiate detoxification (AAOD),neurostimulation leads (Medtronic 3387) were implanted stereotactically in the bilateral NAc.The therapeutic effect was evaluated,also side effects and complications were observed.Periodic questionnaires,psychological scales and symptom scales were included before and after operation respectively.Results The patient ceased drug use completely shortly after the operation.During a following-up period of more than three months,no relapse occurred.This surgical procedure has proved to be mini-invasive and it has fewer side effects than radio-frequency ablation.The comparative results of psychological assessment (WMS,WEIS-RC and MMPI) before and after the operation indicated that there were no obvious changes in the psychohygiene,personality and intelligence.He had a good appetite after the operation,while his weight was increased markedly,and he smoked fewer per day than he did before.Many factors in self-rating symptom scales (SCL-90,SDS and SAS) improved.Conclusion In this study,NAc DBS is used to alleviate opiate drug psychological dependence,and the short-term follow-up showed a satisfactory outcome.