帕金森病深部脑刺激的全身麻醉和无术中微电极记录的效果评价

Evaluation of general anesthesia and without intraoperative microelectrode recording for deep brain stimulation in Parkinson's disease

目的探讨全身麻醉和没有术中微电机记录的DBS治疗帕金森病的效果评价。方法回顾性分析南京医科大学第一附属医院2015年1月至2016年10月共40例帕金森DBS患者,其中局麻下行DBS治疗18例患者,其中10例行MER监测,8例未监测。全麻患者共22例,10行MER监测,12例未监测。术后均行1.5MRI头颅扫描,比较患者第一和第二靶点位置的偏移。比较不同的麻醉方法所耗的手术时间及术后6个月药物关期的UPDRS评分。评价无术中微电机记录对帕金森DBS的影响。结果 (1)帕金森DBS全麻下第一靶点和第二靶点位置偏移无显著性差异,局麻下第一靶点无显著性差异,但第二靶点位置偏移有显著性差异。(2)全麻下行DBS手术比局麻时减少了约2.5小时。(3)全麻和局麻下行DBS术后的帕金森患者UPDRS药物关期时的改善率无显著性差异。(4)有无术中微电机记录的帕金森DBS术后UPDRS药物关期时的改善率无显著性差异。(5)全麻患者的手术依从性明显优于局麻患者,提高了手术的安全性。结论在没有术中微电极记录下全麻行帕金森病DBS是安全且可靠的。

Objective To evaluate the overall effect of DBS in the treatment of Parkinson＇s disease（PD）with general anesthesia and no intraoperative microelectrode.Methods Forty patients with Parkinson＇s disease in the first affiliated hospital of Nanjing medical university from January 2015 to October 2016 were retrospectively analyzed.18 patients with DBS under local anesthesia were treated with DBS.10 of them were monitored with microelectrode and 8 were without microelectrode monitored.Total of 22 patients under general anesthesia,10 were monitored with microelectrode and 12 were not monitored.After operation,all the patients were scanned with 1.5 MRI head,to compare the deviation of the first and second target positions.The operation time of different anesthesia methods and the up score of 6 months after operation were compared.To evaluate the effect of without microelectrode recording on Parkinson＇s DBS.Results（1）There was no significant difference in the first target and second target location deviation under general anesthesia,and there was no significant difference in the first target under local anesthesia,but the second target location shifted significantly.（2）The DBS operation under general anesthesia decreased about 2.5 hours than local anesthesia.（3）There was no significant difference in the improvement rate of Parkinson during the period of turn off in patients with Parkinson＇s disease after general anesthesia and local anesthesia with DBS.（4）There was no significant difference in the improvement rate of up score during the drug period after operation in patients with Parkinson＇s disease recorded by micromotor.（5）The surgical compliance of patients with general anesthesia is better than that of local anesthesia,which improves the safety of operation.ConclusionIt is safe and reliable to record the Parkinson of Parkinson＇s disease under general anesthesia without intraoperative microelectrode.