立体定向伏隔核毁损术治疗酒精依赖患者术后健康状况及生存质量调查

发布时间：2018-06-15 08:21

本文选题：酒精依赖 + 伏隔核　；参考：《第四军医大学》2013年硕士论文

【摘要】：酒精依赖（Alcohol dependence，AD）是由于长期酒精滥用（Alcohol abuse，AA）导致的慢性中枢神经系统严重紊乱，其主要表现为对酒精的渴求和强迫性的饮酒行为。停止饮酒后会出现严重的心理及生理症状，恢复饮酒则这类症状迅速消失，称之为戒断综合征。长期饮酒引起的酒精依赖作为物质滥用的一种也被认为是与中脑边缘多巴胺系统（奖赏环路）密切相关。酒精急性期作用可以改变谷氨酸和γ-氨基丁酸在伏隔核的传递，还能改变中等多棘神经元细胞膜电性能，而长期慢性酒精暴露则可以诱导神经适应性改变，影响多巴胺、谷氨酸、γ-氨基丁酸的释放和基础水平，使体内神经递质的稳态改变。而这种神经适应性变化不但能增加酒精的耐受，还可以引起酒精戒断后心理、生理症状，是酒精戒断综合征形成的主要原因，，如果停止酒精摄入就会产生相应的戒断症状，进而形成对酒精的渴求和依赖，形成强迫性的饮酒行为。立体定向双侧伏隔核毁损术也证明伏隔核是成瘾治疗严重心理依赖及减轻戒断症状的良好靶点，且通过该手术后的随访报告，该手术并发症较少，手术相对安全。本研究通过对33例有严重酒精心理依赖的患者实施了立体定向双侧伏隔核毁损术的手术治疗。通过术后1年对患者随访进行问卷调查，了解患者手术后健康状况及生存质量变化，分析该手术的有效性及安全性。立体定向术后12个月复饮率为12.2%（4,n=33）。并通过对患者术前、术后进行的世界卫生组织生存质量测定量表简表（WHO Quality of life scale，WHOQOL-BREF）及健康状况问卷（Short Form36Health Survey Questionnaire,SF-36）做统计学分析，患者的生存质量及健康状况显著改善。术后患者主观感受明显改善。证明立体定向双侧伏隔核毁损术能够改善严重酒精依赖患者术后生存治质量及健康状况，且并发症少，复饮率低，可以是严重酒精依赖患者的一种治疗选择。
[Abstract]:Alcohol dependence is a kind of chronic central nervous system disorder caused by alcohol abuse for a long time, which is mainly manifested in alcohol craving and compulsive drinking behavior. After stopping drinking, serious psychological and physiological symptoms will appear, and when drinking is resumed, these symptoms will disappear quickly, which is called abstinence syndrome. Alcohol dependence caused by long-term alcohol consumption as a substance abuse is also thought to be closely related to the midbrain marginal dopamine system (reward loop). In acute phase of alcohol, glutamate and 纬 -aminobutyric acid transfer in nucleus accumbens and cell membrane electrical properties of medium isopanacanthate neurons can be changed, while chronic alcohol exposure can induce neuroadaptive changes and affect dopamine. Glutamic acid, 纬-aminobutyric acid release and basic level, make in vivo neurotransmitter homeostasis. This neuroadaptive change can not only increase alcohol tolerance, but also cause psychological and physiological symptoms after alcohol withdrawal, which is the main reason for the formation of alcohol withdrawal syndrome. If alcohol intake is stopped, it will produce corresponding withdrawal symptoms. And then form the thirst and dependence on alcohol, forming compulsive drinking behavior. Stereotactic bilateral nucleus accumbens lesion also proved that nucleus accumbens is a good target for addiction treatment of severe psychological dependence and abstinence symptoms. Through the follow-up report after the operation, the complications of the operation are less and the operation is relatively safe. In this study, 33 patients with severe alcohol dependence were treated with stereotactic bilateral nucleus accumbens lesion. The health status and quality of life (QOL) of the patients after operation were investigated by a questionnaire survey one year after operation, and the effectiveness and safety of the operation were analyzed. The rehydration rate of 12 months after stereotactic operation was 12. 2%. The WHO quality of life scale (WHOQOL-BREF) and the short form 36 Health Survey questionnaire (short form 36 Health Survey questionnaire SF-36) were used to analyze the quality of life and health status of the patients before and after operation. The quality of life and health status of the patients were significantly improved. The subjective feeling of the patients improved significantly after operation. It was proved that stereotactic bilateral nucleus accumbens lesion could improve the quality of survival and health of the patients with severe alcohol dependence, with fewer complications and lower rehydration rate, so it could be a treatment choice for the patients with severe alcohol dependence.
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R749.62

【共引文献】