局部麻醉与全身麻醉下行STN-DBS治疗帕金森病临床效果对比观察

Comparison of clinical effects of STN-DBS in treatment of Parkinson's disease under local anesthesia and general anesthesia

目的对比观察局部麻醉与全身麻醉下行丘脑底核脑深部电刺激术(STN-DBS)治疗帕金森病的临床效果。方法选择帕金森病患者63例,在局部麻醉下行STN-DBS治疗30例(局麻组)、在全身麻醉下行STN-DBS治疗33例(全麻组)。治疗前与治疗后3个月,采用统一帕金森病评定量表Ⅲ(UPDRS-Ⅲ)评分评估运动功能。术中微电极记录STN放电频率;根据放电活动判断STN与微电极的相对位置,计算定位记录长度;术后接受磁共振成像检查,探查计划位置坐标与电极实际植入位置,计算坐标误差。治疗前与治疗后3个月,采用蒙特利尔认知评估量表(MoCA)评分评估认知功能,测量立位与卧位血压、搏动指数(PI)、大脑中动脉平均流速(Vm),计算立位与卧位平均动脉压差值(ΔMAP)、PI差值(ΔPI)、Vm差值(ΔVm)。记录围手术期麻醉、刺激、硬件相关并发症。结果两组治疗后开期和关期UPDRS-Ⅲ评分均低于治疗前(P均<0.05),两组治疗后开期和关期UPDRS-Ⅲ评分比较差异均无统计学意义(P均>0.05)。全麻组STN放电频率、定位记录长度均低于局麻组(P均<0.05),而两组坐标误差比较差异无统计学意义(P>0.05)。两组治疗后MoCA各维度评分均高于治疗前(P均<0.05),两组治疗后MoCA各维度评分比较差异均无统计学意义(P均>0.05)。局麻组治疗后ΔMAP、ΔPI、ΔVm均低于治疗前(P均<0.05),全麻组治疗前后ΔMAP、ΔPI、ΔVm比较差异均无统计学意义(P均>0.05);全麻组治疗后ΔMAP、ΔPI、ΔVm均高于局麻组治疗后(P均<0.05)。局麻组手术当日出现脑出血2例,经保守治疗后好转,两组均未发生其他麻醉、刺激、硬件相关并发症。结论全身麻醉与局部麻醉下行STN-DBS对于改善帕金森病患者运动功能和认知功能的临床效果相当,但全身麻醉下脑血流自动调节功能稳定,有利于准确定位靶点。

Objective To compare the clinical effects of subthalamic nucleus deep brain stimulation(STN-DBS)under local anesthesia and general anesthesia in the treatment of Parkinson's disease.Methods Sixty-three patients with Parkinson's disease were selected,30 patients were treated with STN-DBS under local anesthesia(local anesthesia group)and 33 patients were treated with STN-DBS under general anesthesia(general anesthesia group).The Unified Parkinson's Disease Rating Scale(UPDRS-Ⅲ)was used to assess motor function before treatment and 3 months after treatment.STN discharge frequency was recorded by microelectrode during operation.The relative position of STN and microelectrode was determined according to the discharge activity,and the positioning record length was calculated.After operation,magnetic resonance imaging was performed to explore the planned position coordinates and the actual implantation position of the electrode,and the coordinate errors were calculated.The Montreal Cognitive Assessment Scale(MoCA)was used to assess cognitive function before treatment and 3 months after treatment.Standing and decumbent blood pressure,pulse index(PI),median cerebral artery flow rate(Vm)were measured,and the mean arterial pressure difference(ΔMAP),PI difference(ΔPI),and Vm difference(ΔVm)were calculated.Perioperative anesthesia,stimulation,and hardware-related complications were recorded.Results The UPDRS-Ⅲscores in the opening and closing periods after treatment were lower than those before treatment(all P<0.05),and there was no significant difference in the UPDRS-Ⅲscores in the opening and closing periods between the two groups(P>0.05).STN discharge frequency and positioning record length in the general anesthesia group were lower than those in the local anesthesia group(both P<0.05),but there was no signifi-cant difference in coordinate error between the two groups(P>0.05).The scores of all dimensional MoCA after treatment were higher than those before treatment(all P<0.05),and there were no statistically significant difference in the scores of all dimensions of MoCA between two groups after treatment(all P>0.05).After treatment,ΔMAP,ΔPI andΔVm in local anesthesia group were lower than those before treatment(all P<0.05),and there were no significant differences inΔMAP,ΔPI orΔVm in general anesthesia group before and after treatment(all P>0.05).After treatment,ΔMAP,ΔPI andΔVm in the general anesthesia group were higher than those in the local anesthesia group(all P<0.05).There were 2 cases of intracerebral hemorrhage in the local anesthesia group on the day of operation,which improved after conservative treat-ment,and no other anesthesia,stimulation or hardware-related complications occurred in both groups.Conclusion The clinical effects of STN-DBS under general anesthesia and local anesthesia on motor function and cognitive function of Par-kinson's disease patients are similar,but general anesthesia is conducive to the stability of cerebral blood flow autoregula-tion function and is conducive to accurate target location.