丘脑底核电刺激治疗帕金森病及其术后管理

Subthalamic nucleus deep brain stimulation surgery for patients with Parkinson's disease and the post-operative management

目的探讨丘脑底核电刺激治疗帕金森病术后症状缓解特点,为提高术后患者管理质量提供依据。方法自2008年1月至2009年12月,共34例帕金森病患者于我院接受丘脑底核电刺激手术治疗,其中单侧植入3例,双侧植入31例。术后由神经内外科医师配合对患者进行患者管理。分别于患者首次开机、术后半年和1年时对患者进行UPDRS运动评分,并记录副反应发生情况。结果 34例患者手术顺利,术后平均随访10.6个月。所有患者术后均出现微毁损效应。患者在不服药状态下,术前、首次开机、术后半年和术后1年UPDRS运动评分分别为:46.8±8.9,20.1±9.7,23.1±9.4和22.3±8.9;刺激器打开并服药后,患者症状得到进一步缓解。1例患者术后发生皮肤感染,1例患者发生胸前囊袋积液,经妥善处理后症状控制。结论丘脑底核电刺激治疗帕金森病疗效肯定,高质量的术后患者管理是维持手术疗效的重要环节。

Objective To improve the quality of post-operative patients management by analyzing the characteristics of the syndromes remission after the subthalamic nucleus deep brain stimulation （STN-DBS） in patients with Parkinson＇s disease.Methods There were thirty-four patients receiving the STN-DBS from January 2008 to December 2009 at our DBS center.Thirty-one patients received,Bilateral DBS was performed in thrity-one patients and unilateral DBS in three.The post-operative management of the patients was accomplished by a team composed of the neurosurgeons and neurologists.The UPDRS motor scores were evaluated at the first adjustment,six months and one year after the surgery.The side-effect was also recorded.Results All patients were followed up and the average follow up length was 10.6 months.The UPDRS motor scores under medication off and stimulation on before surgery,first adjustment,six months and one year after the surgery were 46.8±8.9,20.1±9.7,23.1±9.4 and 22.3±8.9,respectively.The UPDRS motor scores in medication and stimulation on were better than those in medication off and stimulation on.Complications including skin infection and subcutaneous effusion occurred in two patients.Those complications were completely controlled after treatment.Conclusions STN-DBS is an effective treatment for patients with advanced parkinson＇s disease.Careful post-operative management is needed to maintain the good effect after the surgery.