本文選題：強迫癥 + 內(nèi)囊前肢毀損　； 參考：《山東大學(xué)》2012年博士論文

【摘要】：目的： 觀察強迫癥患者立體定向內(nèi)囊前肢毀損術(shù)后和伏隔核深部電刺激術(shù)后認(rèn)知功能的變化。觀察外源性磷酸肌酸在改善強迫癥術(shù)后的認(rèn)知功能障礙、減少副作用方面的作用。方法： 將62例行雙側(cè)內(nèi)囊前肢立體定向毀損術(shù)的難治性強迫癥患者隨機分為磷酸肌酸治療組和對照組,治療組在術(shù)后常規(guī)治療的基礎(chǔ)上給予磷酸肌酸鈉治療。選用了20例健康者作為正常對照。同時對6例難治性強迫癥患者行伏隔核深部電刺激術(shù),觀察術(shù)后療效及認(rèn)知功能變化等。對治療組和對照組、深部電刺激組于手術(shù)前及治療后第1、7、30天、6月分別采用簡易智力狀態(tài)量表(MMSE).龔氏修訂的韋氏成人智力測定量表(WAIS—RC)和韋氏記憶量表(WMS)、威斯康星卡片分類測驗一改良版(modified Wisconsin card sorting test,M-WCST)對患者的智力、記憶、執(zhí)行功能等認(rèn)知功能進(jìn)行評定。對3組分別觀察術(shù)后的副作用的發(fā)生情況。在術(shù)后1月和術(shù)后3月,分別采用漢密爾頓抑郁量表和漢密爾頓焦慮量表,Y-BOCS量表對患者的手術(shù)效果進(jìn)行評估。 結(jié)果： 強迫癥患者與正常對照相比,存在智力、記憶、執(zhí)行功能等認(rèn)知功能方面的障礙。立體定向內(nèi)囊前肢毀損術(shù)對智力、記憶、執(zhí)行功能等認(rèn)知功能有負(fù)面影響,術(shù)后分值較術(shù)前降低。在磷酸肌酸治療組,認(rèn)知功能在術(shù)后一周恢復(fù)正常,而對照組一月后才恢復(fù)正常。磷酸肌酸治療組中兩便失禁等副作用發(fā)生率明顯低于對照組。內(nèi)囊前肢立體定向毀損術(shù)后,強迫等核心癥狀較術(shù)前明顯好轉(zhuǎn)。在內(nèi)囊前肢立體定向毀損術(shù)后6月,某些執(zhí)行功能較術(shù)前改善,威斯康星卡片分類測驗中持續(xù)性錯誤較術(shù)前降低。在伏隔核深部電刺激組中,手術(shù)后30天內(nèi)認(rèn)知功能較術(shù)前沒有明顯的改變。術(shù)后半年操作智能較術(shù)前改善,威斯康星卡片分類測驗中持續(xù)性錯誤較術(shù)前減少。結(jié)論外源性磷酸肌酸可促進(jìn)難治性強迫癥患者立體定向內(nèi)囊前肢毀損術(shù)后的認(rèn)知功能障礙的恢復(fù),減少副作用的發(fā)生。在行內(nèi)囊前肢毀損術(shù)后,水腫期后執(zhí)行功能較術(shù)前改善。強迫癥的雙側(cè)伏隔核深部電刺激術(shù)能改善強迫、焦慮、抑郁等核心癥狀,副作用小,手術(shù)操作急性期對認(rèn)知功能影響小,半年隨訪發(fā)現(xiàn)對操作智商有改善作用,在執(zhí)行功能方面,威斯康星卡片分類測驗中持續(xù)性錯誤明顯降低。
[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錛，

本文編號：2034349