脑深部电刺激对帕金森病患者姿势步态和生存质量的影响

Effect of deep brain stimulation on posture,gait and quality of life in patients with Parkinson disease

目的探讨脑深部电刺激(deep brain stimulation,DBS)对帕金森病患者姿势步态和生存质量的影响。方法选取2016年8月至2018年12月于首都医科大学宣武医院就诊的86例原发性帕金森病患者为研究对象,根据患者的治疗方式将其分为观察组和对照组,每组各43例。对照组患者接受个体化药物治疗,观察组患者在对照组治疗基础上接受双侧丘脑底核DBS治疗。比较两组患者治疗前和治疗后12个月姿势控制系统功能、步态状况、生活自理能力和生存质量,并分析DBS的安全性。结果两组患者治疗后12个月股四头肌肌力、伯格平衡量表(Berg balance scale,BBS)评分、日常生活能力评定量表(activity of daily living scale,ADL量表)评分均显著高于本组治疗前(均P<0.05),步速均显著大于本组治疗前(均P<0.05),静态跌倒风险指数(static fall index,SFI)量表评分、冻结步态问卷(freezing of gait questionnaire,FOGQ)评分、39项帕金森病生存质量调查问卷(Parkinson disease quality of life questionnaire-39,PDQ-39)评分均显著低于本组治疗前(均P<0.05),步长均显著长于本组治疗前(均P<0.05)。观察组患者治疗后12个月股四头肌肌力、BBS评分、ADL量表评分均显著高于对照组(均P<0.05),步速显著大于对照组(P<0.05),SFI量表评分、FOGQ评分、PDQ-39评分均显著低于对照组(均P<0.05),步长显著长于对照组(P<0.05)。观察组患者术后1年共13例发生术后并发症,发生率为30.2%,包括精神症状6例,切口延迟愈合3例,构音障碍2例,肺炎2例。经过积极的对症处理后症状基本消失,未出现睁眼困难、认知障碍、自杀行为等严重并发症。结论DBS能在短期内显著改善帕金森病患者的姿势控制功能与步态状况,提高患者生活自理能力与生存质量,安全可靠。

Objective To study the effect of deep brain stimulation(DBS)on posture,gait and quality of life in patients with Parkinson disease(PD).Method Eighty-six patients with PD treated in Xuanwu Hospital Capital Medial University from August 2016 to December 2018 were enrolled for the study.According to patients'treatment methods,they were divided into observation group and control group,with 43 cases in each group.Patients in control group were given individualized drug treatment.On this basis,patients in observation group were given DBS of bilateral subthalamic nucleus.The function of posture control system,gait status,self-care ability and quality of life before and 12 months after treatment were compared between the two groups,and the safety of DBS was analyzed in observation group.Result At 12 months after treatment,the quadriceps femoris muscle strengths,Berg balance scale(BBS)scores and activity of daily living scale(ADL scale)scores in the two groups were significantly higher than those before treatment(all P<0.05),and the walk velocities were significantly higher than those before treatment(all P<0.05),the static fall index(SFI)scale scores,the freezing of gait questionnaire(FOGQ)scores and the Parkinson disease quality of life questionnaire-39(PDQ-39)scores were all significantly lower than those before treatment(all P<0.05),the step lengths were significantly longer than those before treatment(all P<0.05).At 12 months after treatment,the quadriceps femoris muscle strength,BBS score and ADL score of patients in observation group were significantly higher than those in control group(all P<0.05),and the walk velocity was significantly higher than that in control group(P<0.05),the SFI scale score,FOGQ score and PDQ-39 score were all significantly lower than those in control group(all P<0.05),and the step length was significantly longer than that in control group(P<0.05).In the observation group,13 cases(30.2%)experienced postoperative complications 1 year after operation,including 6 cases of mental symptoms,3 cases of delayed wound healing,2 cases of dysarthria and 2 cases of pneumonia.The symptoms basically disappeared after active symptomatic treatment,and no serious complications such as difficulty in opening eyes,cognitive impairment,and suicidal behavior occurred.Conclusion DBS can significantly improve the posture control function and gait status of PD patients,improve the ability of self-care and quality of life in a short period of time,which is safe and reliable.