脑深部电刺激对帕金森病非运动症状的影响

发布时间：2018-04-15 19:07

本文选题：帕金森病 + 丘脑底核　；参考：《济南大学》2017年硕士论文

【摘要】：目的分别对22例行DBS治疗的PD患者进行术前1周(关期)、服药(开期)及DBS术后6个月开机未服药、开机服药两种状态下进行运动功能、生活能力评估,同时进行术前、术后非运动症状相关量表的评估,观察运动功能、生活能力及抑郁、焦虑、认知、睡眠障碍、流涎等非运动症状的改善;探讨DBS治疗对PD患者非运动症状的影响。方法连续收集2015年1月至2016年1月在济宁市人民医院帕金森门诊就诊,确诊为原发性帕金森病,经病情评估、多巴胺激发试验符合行STN-DBS手术标准的病例。术前1周及术后6个月进行评估:病情分级选用H-Y分级,运动障碍功能检测采用统一帕金森病评定量表II、III部分(UPDRSII、III);非运动症状采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、简易精神状态量表(MMSE)、匹兹堡睡眠质量指数(PSQI)、唾液分泌临床分级(SCS-PD)等量表分别对抑郁、焦虑、认知、睡眠障碍、唾液分泌进行评价。分为术前组与术后6个月组作为自身前后对照组。同时收集STN-DBS组患者的术后不良反应,包括异动、心慌、头晕、头胀、感觉异常、视物模糊、构音障碍、抽搐、肌张力障碍。结果帕金森患者STN-DBS术后6个月开机未服药状态与术前关期状态下比较,以及术后6个月开机服药状态与术前1周服药状态下比较,其UPDRSII、III比较有明显改善(P0.001);非运动症状HAMD、HAMA、MMSE量表结果显示DBS治疗6个月后PD患者抑郁、焦虑、认知程度均有不同程度改善(P0.001),其中认知改善率较低;PQSI、SCS-PD量表评分也有不同程度改善(P0.001),且病程严重程度对焦虑、抑郁、认知、流涎、睡眠均有影响,患者行DBS手术安全性较高,大多数患者无明显不适,少数患者开机时可出现头晕、头胀、心慌、视物模糊、四肢发紧以及麻木等异常感觉,通过调整刺激参数、降低电压后症状减轻或者消失,3例病人开机刺激时出现异动症,通过降低刺激强度,减少左旋多巴制剂剂量,病人异动症消失。结论在接受双侧STN-DBS术治疗的22例患者中,运动症状治疗效果确切,对非运动症状均有不同程度的改善,未发现严重并发症。
[Abstract]:Objective to evaluate the motor function and life ability of 22 PD patients who were treated with DBS for 1 week before operation and 6 months after DBS.To investigate the effects of DBS treatment on non-motor symptoms in PD patients, the evaluation of non-motor symptom related scale, the improvement of motor function, life ability and depression, anxiety, cognition, sleep disorder, salivation and other non-motor symptoms were observed.Methods from January 2015 to January 2016, patients with primary Parkinson's disease were diagnosed at Parkinson's Clinic of Jining people's Hospital. According to the evaluation of the disease, dopamine stimulation test met the standard of STN-DBS operation.One week before operation and 6 months after operation, H-Y grade was selected.Motor dysfunction was measured with the Unified Parkinson's Disease rating scale (II), part III of the Parkinson's Disease rating scale (IIP), the Hamilton Depression scale (Hamd), the Hamilton anxiety scale (Hamaa), the Mini-Mental State scale (MMSE), the Pittsburgh Sleep quality Index (PSQI), and saliva.The scale of secreting clinical grade and SCS-PDwere used to treat depression,Anxiety, cognition, sleep disorders, saliva secretion were evaluated.The patients were divided into preoperative group and 6 month group as the control group before and after operation.At the same time, the adverse reactions of STN-DBS group were collected, including abnormal movement, palpitation, dizziness, head distension, abnormal sensation, blurred vision, dysarthria, convulsion, dystonia.Results the state of no medication at 6 months after STN-DBS was compared with the state of closing before operation, and the state of taking medicine at 6 months after operation was compared with that of 1 week before operation.The results of DBS showed that PD patients were depressed and anxious 6 months after treatment with DBS.The cognitive improvement rate was lower and the score of PQSISCS-PD was improved to some extent, and the severity of the disease had influence on anxiety, depression, cognition, salivation, sleep, and the safety of DBS was higher.Most patients have no obvious discomfort, a few patients can appear dizziness, head distension, panic, blurred vision, limb tightening and numbness, etc., by adjusting the stimulation parameters,After lowering the voltage, the symptoms were alleviated or disappeared in 3 patients with hyperactivity. By reducing the intensity of stimulation and reducing the dosage of levodopa preparation, the patients with dyskinesia disappeared.Conclusion among the 22 patients treated with bilateral STN-DBS, the therapeutic effect of motor symptoms was definite, and the non-motor symptoms were improved to some extent, and no serious complications were found.
【学位授予单位】：济南大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.5

【参考文献】