立体定向外科手术对难治性强迫症认知功能的影响及干预措施

发布时间：2018-06-18 05:36

  本文选题：强迫症 + 内囊前肢毁损　； 参考：《山东大学》2012年博士论文

【摘要】：目的： 观察强迫症患者立体定向内囊前肢毁损术后和伏隔核深部电刺激术后认知功能的变化。观察外源性磷酸肌酸在改善强迫症术后的认知功能障碍、减少副作用方面的作用。方法： 将62例行双侧内囊前肢立体定向毁损术的难治性强迫症患者随机分为磷酸肌酸治疗组和对照组,治疗组在术后常规治疗的基础上给予磷酸肌酸钠治疗。选用了20例健康者作为正常对照。同时对6例难治性强迫症患者行伏隔核深部电刺激术,观察术后疗效及认知功能变化等。对治疗组和对照组、深部电刺激组于手术前及治疗后第1、7、30天、6月分别采用简易智力状态量表(MMSE).龚氏修订的韦氏成人智力测定量表(WAIS—RC)和韦氏记忆量表(WMS)、威斯康星卡片分类测验一改良版(modified Wisconsin card sorting test,M-WCST)对患者的智力、记忆、执行功能等认知功能进行评定。对3组分别观察术后的副作用的发生情况。在术后1月和术后3月,分别采用汉密尔顿抑郁量表和汉密尔顿焦虑量表,Y-BOCS量表对患者的手术效果进行评估。 结果： 强迫症患者与正常对照相比,存在智力、记忆、执行功能等认知功能方面的障碍。立体定向内囊前肢毁损术对智力、记忆、执行功能等认知功能有负面影响,术后分值较术前降低。在磷酸肌酸治疗组,认知功能在术后一周恢复正常,而对照组一月后才恢复正常。磷酸肌酸治疗组中两便失禁等副作用发生率明显低于对照组。内囊前肢立体定向毁损术后,强迫等核心症状较术前明显好转。在内囊前肢立体定向毁损术后6月,某些执行功能较术前改善,威斯康星卡片分类测验中持续性错误较术前降低。在伏隔核深部电刺激组中,手术后30天内认知功能较术前没有明显的改变。术后半年操作智能较术前改善,威斯康星卡片分类测验中持续性错误较术前减少。结论外源性磷酸肌酸可促进难治性强迫症患者立体定向内囊前肢毁损术后的认知功能障碍的恢复,减少副作用的发生。在行内囊前肢毁损术后,水肿期后执行功能较术前改善。强迫症的双侧伏隔核深部电刺激术能改善强迫、焦虑、抑郁等核心症状,副作用小,手术操作急性期对认知功能影响小,半年随访发现对操作智商有改善作用,在执行功能方面,威斯康星卡片分类测验中持续性错误明显降低。
[Abstract]:Objective:
To observe the changes of cognitive function after the stereotactic stereotactic internal capsule anterior limb damage and the deep electric stimulation of the nucleus accumbens. The effect of exogenous creatine phosphate on cognitive impairment and side effects after obsessive-compulsive disorder was observed.
62 cases of intractable obsessive-compulsive disorder treated with stereotactic stereotactic lesion of bilateral internal capsule were randomly divided into creatine phosphocreatine treatment group and control group. The treatment group was treated with sodium phosphocreatine on the basis of routine postoperative treatment. 20 healthy subjects were selected as normal control. 6 patients with refractory obsessive-compulsive disorder were treated with deep electrical stimulation of the nucleus accumbens. The treatment group and the control group, the treatment group and the control group, the deep electrical stimulation group before and after the treatment on day 1,7,30, the simple intelligence state scale (MMSE) in June respectively. Gong's revised Wechsler Intelligence Scale (WAIS - RC) and Wechsler's Memory Scale (WMS), a modified version of the Wisconsin card classification test (modified Wisconsin card sorting test, M-WCST) to evaluate the cognitive function of the patient's intelligence, memory, and executive function. The 3 groups were observed after the operation. In January and March after the operation, the Hamilton depression scale and the Hamilton anxiety scale were used respectively, and the Y-BOCS scale was performed on the surgical effect of the patients. Assessment.
Result锛，

本文编号：2034349