帕金森病患者脑深部电刺激术后综合管理对其平衡障碍的作用研究

A study on the effect of comprehensive management on the balance disorder of Parkinson′s dis⁃ease patients after deep brain stimulation

目的 探讨原发性帕金森患者丘脑底核脑深部电刺激术后综合管理下平衡障碍的改善。方法 以16例原发性帕金森病经双侧丘脑底核脑深部电刺激术(STN-DBS)治疗的患者为研究对象(男8人,女8人,年龄中位数为60.5岁,病程中位数9年,所有患者均为H&Y3期),术后患者综合管理包括DBS程控、药物调整、康复锻炼及心理辅导。分别在不同时间点[手术前(药物关期/开期)、术后开机(刺激关期/药物关期、刺激开期/药物关期、刺激开期/药物开期)及术后6个月(刺激开期/药物关期、刺激开期/药物开期)、术后12个月(刺激开期/药物关期、刺激开期/药物开期)]对患者左旋多巴等效日剂量(LEDD)、生活质量(PDQ-39)、运动功能(MDS-UPDRSⅢ评分)及平衡功能(MDS-UPDRS 3.12、Berg Balance Scale BBS和稳定极限)进行评估。结果 16例患者随访期间患者LEDD明显下降(P<0.05);随访期间患者PDQ-39评分显著改善(P<0.05);术后Stim on/Med off状态下MDS-UPDRSⅢ较术前Med off明显改善(P<0.05),随访期间相同状态下MDS-UPDRSⅢ持续改善,12个月患者MDS-UPDRSⅢ评分呈最佳状态(P<0.05)。平衡相关评分(MDS-UPDRS,item 3.12及BBS)术后Stim on/Med off状态下较术前Med-off未见明显改善(P>0.05),但与术后6个月Stim on/Med off状态各项评分有统计学差异(P<0.05),术后12个月Stim on/Med off状态各项评分持续改善(P<0.05)。患者术后Stim on/Med off状态稳定极限评估(目标获得百分比、躯干摆动角度标准差、时间)与术前Med off、术前Med on及术后Stim off/Med off明显改善(P<0.05)。结论 STN-DBS术后多学科综合管理有利于改善平衡功能。

Objective To investigate the effect of multi⁃disciplinary teamwork on balance performance in Parkinson′s disease(PD)with bilateral STN⁃Deep Brain Stimulation.Methods 16 primary Parkinson′s disease(8 male,8 female)treated with bilateral subthalamic nucleus deep brain stimulation(STN⁃DBS)were included in the study.The median age of patients was 60.5 years;all patients were in H&Y 3 stage;the median PD duration of the disease was 9 years.For each patient,multi⁃disciplinary teamwork treatment including DBS,medication,physical therapy and psychotherapy was proceeded.LEDD,Motor disability(MDS⁃UPDRSIII),life quality(PDQ⁃39)and balance performance(MDS⁃UPDRS 3.12,Berg Balance Scale,BBS Limits of Stability,LoS)were assessed in different time and status respective⁃ly:pre⁃operation(Med⁃off,Med⁃on),post⁃operation(Stim⁃Off/Med⁃Off,Stim⁃On/Med⁃Off,Stim⁃On/Med⁃On),6 months postoperation(Stim⁃On/Med⁃Off,Stim⁃On/Med⁃On)and 12 months postoperation(Stim⁃On/Med⁃Off,Stim⁃On/Med⁃On).Results The LEDD of the 16 patients was significantly decreased during the follow⁃up(P<0.05).The life quality(PDQ⁃39)score was significantly improved during the follow⁃up(P<0.05).The Motor disability(MDS⁃UPDRSIII)was significantly improved in the postoperation Stim on/Med off state(P<0.05),the MDS⁃UPDRS III score was optimal at 12 months post⁃operation(P<0.05).Balance⁃related scores(MDS⁃UPDRS,item 3.12 and BBS)showed no significant improvement(P>0.05)compared with preoperation Med⁃off,postoperation Stim on/Med off,and Stim on/Med off state at 6 months postoperation.The scores were statistically different(P<0.05),and the scores of Stim on/Med off state continued to improve at 12 months postoperation(P<0.05).The limit of stability assessment of postoperation Stim on/Med off state(target acquisition percentage,body swing angle stan⁃dard deviation,time)were significantly improved(P<0.05)compared with the preoperation Med off,pre⁃operative Med on and postoperation Stim⁃off/Med⁃off.Conclusion Multi⁃disciplinary teamwork for PD patients with STN⁃DBS could improve balance performance.