本文選題：帕金森病 + 丘腦底核��； 參考：《濟(jì)南大學(xué)》2017年碩士論文

【摘要】：目的分別對(duì)22例行DBS治療的PD患者進(jìn)行術(shù)前1周(關(guān)期)、服藥(開(kāi)期)及DBS術(shù)后6個(gè)月開(kāi)機(jī)未服藥、開(kāi)機(jī)服藥兩種狀態(tài)下進(jìn)行運(yùn)動(dòng)功能、生活能力評(píng)估,同時(shí)進(jìn)行術(shù)前、術(shù)后非運(yùn)動(dòng)癥狀相關(guān)量表的評(píng)估,觀察運(yùn)動(dòng)功能、生活能力及抑郁、焦慮、認(rèn)知、睡眠障礙、流涎等非運(yùn)動(dòng)癥狀的改善;探討DBS治療對(duì)PD患者非運(yùn)動(dòng)癥狀的影響。方法連續(xù)收集2015年1月至2016年1月在濟(jì)寧市人民醫(yī)院帕金森門診就診,確診為原發(fā)性帕金森病,經(jīng)病情評(píng)估、多巴胺激發(fā)試驗(yàn)符合行STN-DBS手術(shù)標(biāo)準(zhǔn)的病例。術(shù)前1周及術(shù)后6個(gè)月進(jìn)行評(píng)估:病情分級(jí)選用H-Y分級(jí),運(yùn)動(dòng)障礙功能檢測(cè)采用統(tǒng)一帕金森病評(píng)定量表II、III部分(UPDRSII、III);非運(yùn)動(dòng)癥狀采用漢密爾頓抑郁量表(HAMD)、漢密爾頓焦慮量表(HAMA)、簡(jiǎn)易精神狀態(tài)量表(MMSE)、匹茲堡睡眠質(zhì)量指數(shù)(PSQI)、唾液分泌臨床分級(jí)(SCS-PD)等量表分別對(duì)抑郁、焦慮、認(rèn)知、睡眠障礙、唾液分泌進(jìn)行評(píng)價(jià)。分為術(shù)前組與術(shù)后6個(gè)月組作為自身前后對(duì)照組。同時(shí)收集STN-DBS組患者的術(shù)后不良反應(yīng),包括異動(dòng)、心慌、頭暈、頭脹、感覺(jué)異常、視物模糊、構(gòu)音障礙、抽搐、肌張力障礙。結(jié)果帕金森患者STN-DBS術(shù)后6個(gè)月開(kāi)機(jī)未服藥狀態(tài)與術(shù)前關(guān)期狀態(tài)下比較,以及術(shù)后6個(gè)月開(kāi)機(jī)服藥狀態(tài)與術(shù)前1周服藥狀態(tài)下比較,其UPDRSII、III比較有明顯改善(P0.001);非運(yùn)動(dòng)癥狀HAMD、HAMA、MMSE量表結(jié)果顯示DBS治療6個(gè)月后PD患者抑郁、焦慮、認(rèn)知程度均有不同程度改善(P0.001),其中認(rèn)知改善率較低;PQSI、SCS-PD量表評(píng)分也有不同程度改善(P0.001),且病程嚴(yán)重程度對(duì)焦慮、抑郁、認(rèn)知、流涎、睡眠均有影響,患者行DBS手術(shù)安全性較高,大多數(shù)患者無(wú)明顯不適,少數(shù)患者開(kāi)機(jī)時(shí)可出現(xiàn)頭暈、頭脹、心慌、視物模糊、四肢發(fā)緊以及麻木等異常感覺(jué),通過(guò)調(diào)整刺激參數(shù)、降低電壓后癥狀減輕或者消失,3例病人開(kāi)機(jī)刺激時(shí)出現(xiàn)異動(dòng)癥,通過(guò)降低刺激強(qiáng)度,減少左旋多巴制劑劑量,病人異動(dòng)癥消失。結(jié)論在接受雙側(cè)STN-DBS術(shù)治療的22例患者中,運(yùn)動(dòng)癥狀治療效果確切,對(duì)非運(yùn)動(dòng)癥狀均有不同程度的改善,未發(fā)現(xiàn)嚴(yán)重并發(fā)癥。
[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.
【學(xué)位授予單位】：濟(jì)南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R742.5

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 楊榮文;常履華;;帕金森病患者的認(rèn)知功能障礙[J];醫(yī)學(xué)綜述;2011年17期

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本文編號(hào)：1755396