丘脑底核脑深部刺激术的参数设置及调整

Establishment and adjustment of parameters for deep brain stimulation of the subthalamic nucleus

目的探讨帕金森病(PD)丘脑底核(STN)脑深部刺激术(DBS)术中、术后脉冲发生器的参数调整。方法回顾采用STN-DBS治疗的62例帕金森病病人的病历资料,对病人术中及术后刺激参数的调整进行分析。结果32例行单侧手术者均接受单极刺激;30例行双侧手术病人中,接受双侧双极刺激25例,双侧单极刺激2例,一侧单极刺激、另一侧双极刺激3例。7例触点调整均为上移。统一帕金森病评定量表(UPDRS)运动评分改善率双侧刺激优于单侧刺激。本组刺激参数为:电压双极1～4V,单极1～3.5V;脉宽60～120μs;频率180～190Hz。结论STN-DBS术后病人采用适当刺激参数可获得安全可靠的疗效,电压调整对PD症状控制作用明显,脉宽及频率的调整相对较少;双侧刺激效果更佳。

Objective To explore the parameter adjustment during and after deep brain stimulation （DBS） of the subthalamic nucleus （STN） in Parkinson＇s disease （PD） patient. Methods Data of 62 PD patients undergoing STN-DBS were reviewed and the adjustment of stimulation parameters during and after the operation was analyzed retrospectively. Results Monopolar stimulation was used in 32 patients who underwent unilateral operation, while in 30 patients undergoing bilateral operations, 25 were stimulated by bipolar model, 2 by monopolar model, and 3 by monopolar stimulation in one side and bipolar in another side. Superior shift of electrode contact point was found in 7 cases. UPDRS motor score improvement of bilateral stimulation was better than that of unilateral stimulation. Parameter settings in this group were： voltage 1-4 V （bipolar）, 1-3.5 V （monopolar）, pulse width 60-120 μs, and frequency 180-190 Hz. Conclusion Proper parameter settings of STN-DBS can gain safe and reliable therapeutic effects in PD patients. Voltage adjustment can markedly control PD symptoms, while adjustment of pulse width or frequency is less used relatively, and bilateral STN-DBS leads to better symptomatic improvement of PD.