帕金森病脑深部电刺激术后并发症及相关因素分析

Analysis of postoperative complications and related factors of DBS in Parkinson's disease

目的分析脑深部电刺激术治疗原发性帕金森病患者并发症及相关危险因素。方法回顾性分析2014年~2016年长海医院脑深部电刺激术治疗原发性帕金森病患者(n=349),收集患者性别、年龄、病程、既往病史、吞咽情况、住院时间、并发症等临床资料,并对引起并发症的相关危险因素进行分析。结果帕金森DBS术后出现并发症患者共34例,发生率9.74%,其中颅内出血10例,肺部感染10例,术后电解质紊乱11例,泌尿系感染3例,DBS患者平均住院时间5.66±1.45天,出现术后并发症的患者平均住院时间15.18±14.03天。脑出血患者围手术期收缩压145±15.52 mmHg(125~170 mmHg),舒张压89.64±10.65 mmHg(75~108 mmHg),高血压患者8人,3例患者收缩压>160 mmHg,高血压患者出血风险明显高于非高血压患者(P=0.003)。肺炎患者吞咽等级2.10±1.29,非肺炎患者吞咽等级0.96±0.83,两者相比较显示,肺部感染患者吞咽等级明显高于非肺部感染患者(t=4.199,P<0.0001)。结论颅内出血和肺部感染是帕金森患者DBS手术最常见和最严重的并发症,患者血压及吞咽等级分别是颅内出血和肺部感染最重要的影响因素。

Objective To analyze the complications and risk factors of deep brain stimulation in patients with primary Parkinson’s disease.Methods Retrospective analysis was performed on patients with primary Parkinson’s disease(n=349) treated with deep brain stimulation in Changhai Hospital from 2014 to 2016.Clinical data including gender, age, course of disease, previous medical history, deglution, length of stay and complications, annlysis related risk factors.Results There were 34 patients with postoperative complications of Parkinson’s DBS,with an incidence of 9.74%,including 10 cases of intracranial hemorrhage, 10 cases of pulmonary infection, 11 cases of postoperative electrolyte disturbance, and 3 cases of urinary tract infection.The average length of hospital stay of DBS patients was 5.66±1.45 days, and the average length of hospital stay of patients with postoperative complications was 15.18±14.03 days.The perioperative systolic blood pressure of patients with cerebral hemorrhage was 145±15.52 mmHg(125~170 mmHg),diastolic blood pressure was 89.64±10.65 mmHg(75~108 mmHg),and the systolic blood pressure of 3 patients with hypertension was >160 mmHg.The bleeding risk of patients with hypertension was significantly higher than that of patients without hypertension(P=0.003).The swallowing grade of pneumonia patients was 2.10±1.29,and that of non-pneumonia patients was 0.96±0.83.The comparison between the two showed that the swallowing grade of pulmonary infection patients was significantly higher than that of non-pulmonary infection patients(t=4.199,P <0.0001).Conclusion Intracranial hemorrhage and pulmonary infection are the most common and serious complications of DBS in patients with Parkinson’s disease.Patients’ blood pressure and swallowing grade are the most important influencing factors of intracranial hemorrhage and pulmonary infection, respectively.