3例难治性癫痫患者行迷走神经刺激术的护理配合

迷走神经刺激术(vagus nerve stimulation,VNS)作为一种治疗难治性癫痫的辅助治疗方法,近年来已经被逐步应用于临床,并取得良好的效果.本文总结了3例行VNS的患者的术前、术中及术后随访,并对知识宣教、手术室环境准备及手术中的配合重点进行了详细阐述.3例手术均获得成功,癫痫症状得到控制,患者对治疗效果满意.     

迷走神经刺激术治疗顽固性癫痫患者的护理

癫痫是一组由脑部和全身疾病等原因所引起的反复发作性、短暂性、脑功能障碍的综合征[1].WHO流行病学调查[2]表明,即使最有效的保守治疗,仍有30％～40％的癫痫发作难以控制,变为难治性癫痫.部分患者致痫灶定位困难,或者存在多个致病灶,切除手术难以奏效.迷走神经刺激术( vagus nerve stimulation,VNS)无需对致痫灶进行精确定位,通过刺激迷走神经可使癫痫的发作次数减少,对部分患者甚至可以完全控制,为不能进行切除手术或切除术后复发的顽固性癫痫患者开辟了新的治疗途径.且此手术是一种相对安全、有效的治疗方法,具有创伤小,不良反应少等优点[ 3].2009年1月至2010年12月,我院完成VNS手术32例,本文对术中护理配合情况进行总结,现报道如下.     

唤醒麻醉联合电刺激技术应用于语言功能区癫痫手术的效果

目的探讨唤醒麻醉联合电刺激技术应用于语言功能区癫痫手术中的效果。方法选取25例行全身麻醉术的语言功能区癫痫患者,术中予以唤醒并进行皮层电刺激定位语言功能区,根据皮层脑电图定位的致痫灶与语言功能区关系选择相应手术方式,并且在切除致痫灶时作皮层电刺激以保护语言功能区。观察术中情况、手术前后语言功能、病理结果及癫痫控制效果[采用恩格尔癫痫预后分级(Engel)评价]。结果 1)术中情况:术中脑膨出2例均经相应处理后恢复正常颅内压,术中电刺激引发癫痫发作4例;2)术后病理结果:胶质增生8例,局灶性皮层发育不良(FCD)7例,海绵状血管瘤4例,星形细胞瘤3例,结节性硬化3例;3)手术前后语言功能:与术前比较,患者术后失语、构音障碍和图片命名功能无明显变化,差异无统计学意义(P>0.05);4)癫痫控制效果:EngelⅠ级17例,EngelⅡ级7例,EngelⅢ级1例。结论全身麻醉术中唤醒电刺激技术可以准确定位语言功能区,提高邻近语言功能区癫痫病例的手术疗效和安全性。     

难治性癫痫患儿行迷走神经刺激术的围术期护理

[目的]探讨难治性癫痫患儿行迷走神经刺激术的护理方法,为难治性癫痫患儿及其家属提供护理指导。[方法]回顾性分析9例难治性癫痫行迷走神经刺激术患儿的护理资料,着重从健康教育、癫痫发作的观察与护理、术前手术禁忌证的排查、抗癫痫用药指导及术后并发症的观察护理,重视患儿及家属的心理问题,及时提供护理干预。[结果]通过优质的护理服务,9例患儿均顺利度过围术期,患儿及家属对治疗满意,患儿生活质量有所提高,无术后并发症发生。[结论]优质的护理服务能提高迷走神经刺激术疗效,提高患儿生活质量。     

迷走神经电刺激临床应用及机制研究进展

<正>迷走神经电刺激(vagus nerve stimulation,VNS)是指用一种可植入装置刺激迷走神经的治疗方法,即通过外科手术将螺旋电极缠绕于颈部内迷走神经上,将刺激装置埋在胸前,调整装置参数与模式,使刺激器自动刺激迷走神经达到治疗目的。迄今为止,全世界已有5万多例患者接受了这种治疗,主要应用于难治性癫痫和持续性、复发性抑郁,此外,VNS对记忆功能障碍、脑外伤、脑缺血的改善作用也得到越     

迷走神经刺激术与难治性癫痫

癫痫是一种常见的、反复发作的慢性神经疾病，发病率高。自1970年以来，有多种抗癫痫药世物问，但仍有约1／3的难治性癫痫患者的发作不能得到满意的控制，另外还有部分患者难以承受药物的毒副作用。这中间约有7％～8％的患者由于病灶容易确定，可以通过手术取得满意的疗效，但仍有一些患者缺乏有效的治疗措施。20世纪80年代中期开始出现的迷走神经刺激术（vagus nerve stimulation，VNS）为这一问题的解决提供了一个新的途径。1997年美国FDA正式批准VNS作为12岁以上的难治性部分性癫痫的辅助治疗。     

迷走神经刺激治疗难治性癫痫的研究现状

采用植入式刺激器对迷走神经进行慢性、间歇性电刺激是一项控制难治性癫痫的有效手段,它可以显著降低癫痫发作的频率和严重程度,并且提高患者生存质量,但其治疗机制仍未明了。本文介绍了迷走神经刺激（VNS）装置埋植和设置方法,并回顾了VNS抗癫痫的临床效能和不良反应,最后从神经解剖、神经电生理、脑功能成像等多方面对其疗效机制进行综述。     

迷走神经刺激术(VNS)治疗8例药物难治性癫痫的护理

总结了采用迷走神经电极置入刺激术治疗8例药物难治性癫痫的围手术期护理,主要包括完善术前准备和心理护理,术后密切观察病情变化以及防止并发症的发生,并对患者及家属进行健康指导。结果,8例患者迷走神经刺激器均顺利植入,随访1-6个月,未出现出血、感染、神经或血管损伤等情况,癫痫发作次数减少,随访治疗效果稳定,生活质量均有明显提高。认为术前的心理辅导、术后细致的观察与精心的护理和出院指导是确保手术效果的重要措施。     

迷走神经刺激术治疗难治性癫痫患者预后的现状调查研究

目的调查迷走神经刺激术治疗难治性癫痫患者预后现状,探讨影响疗效的因素。方法选取2016年8月至2018年6月我院住院治疗的采用迷走神经刺激术治疗的难治性癫痫患者80例,调查术后12个月内癫痫发作频率,发作频率减少在≥50%以上设为有效组,50%以下设为无效组,采用多因素logistic回归分析确定影响疗效因素。结果80例术后12个月发作频率平均减少(54.65±7.03)%。有效50例,发作频率减少(61.23±6.43)%;无效30例,发作频率减少(43.11±5.91)%;病程≥5年、主要照顾者疾病知识差、全面性强直阵挛发作(CS)是迷走神经刺激术治疗难治性癫痫预后的独立危险因素(P<0.05)。结论迷走神经刺激术治疗难治性癫痫能有效减少发作频率,但疗效受到病程、主要照顾者疾病知识、术前发作类型等影响,可开展针对性护理措施提高预后效果。     

迷走神经刺激的启动时间对抗癫痫作用的影响

背景长期反复痫性发作可影响记忆功能以及发生许多意料不到的并发症.如何控制和预防其发作是临床和康复医学研究的重点.目的应用大鼠癫痫模型,探讨迷走神经刺激(vagus nerve stimulation.VNS)治疗癫痫的最佳启动时间.设计随机对照的实验研究.地点和对象实验地点首都医科大学神经生物学研究室.实验对象Wistar大鼠34只,二级,首都医科大学实验动物中心提供.方法应用海人酸(kainic acid,KA)复制大鼠癫痫模型,以大鼠皮质电图(electrocorticographic,ECoG)和行为学为观测指标,在癫痫发作前后分别刺激左侧迷走神经,比较两组迷走神经刺激不同的启动时间对癫痫发作持续时间的影响,确定迷走神经刺激输出的最佳时机.主要观察指标①海人酸诱发癫痫的潜伏期和持续期.②VNS的启动时间对控制癫痫发作的影响.结果在癫痫发作前,间断刺激迷走神经50 min,可显著降低癫痫发作的严重程度、缩短发作的持续时间,甚至完全抑制癫痫发作.而发作一旦发生再行该组合刺激,则只能降低发作的严重程度、缩短发作的持续期,而不能完全阻抑癫痫发作.发作前后进行迷走神经刺激的抗痫效果之间存在显著性差异(F=27.320,P＜0.01).结论在癫痫发作前及时启动VNS可以显著提高VNS的抗痫效果,适宜的刺激参数组合是控制癫痫发作的关键,并为其预防发作奠定实验基础.     

Preliminary analysis of the effect of vagus nerve stimulation in the treatment of children with intractable epilepsy

BACKGROUNDImplant vagus nerve stimulation is an adjunctive treatment for intractable epilepsy when patients are not suitable for resective surgery.AIMTo identify the safety and efficacy of vagus nerve stimulation in children with intractable epilepsy and analyze the effects on different epilepsy syndromes.METHODSEligible children with intractable epilepsy were admitted to the study. We collected data from preoperative assessments as the baseline. During the follow-up time, we recorded the process of seizures (frequency, duration, and seizure type), the changes of drugs or parameters, the complications, etc. The mean reduction rate of seizures, response rate, and McHugh scale were chosen as the outcomes.RESULTSA total of 213 patients were implanted with Tsinghua Pins vagus nerve stimulators, and the average age was 6.6 years. In the follow-up time of postoperative 3 mo, 6 mo, 12 mo, 18 mo, and 24 mo, the average reduction rate was 30.2%, 49.5%, 56.3%, 59.4%, and 63.2%, while the response rate was 21.8%, 62.5%, 57.1%, 69.2%, and 70.7%. In addition, implanted vagus nerve stimulation had different effects on epilepsy syndromes. The reduction rate of West syndrome increased from 36.4% (postoperative 6 m) to 74.3% (postoperative 24 m). The reduction rate of Lennox-Gastaut syndrome improved from 25.4% to 73.1% in 24 mo. The chi-square test of the five efficacy grades showed P < 0.05. The comparison between the 3-mo follow-up and the 6-mo follow-up showed P < 0.05, and the comparison between the 6-mo follow-up and the 24-mo follow-up showed P > 0.05.CONCLUSIONVagus nerve stimulation is safe and effective in children with intractable epilepsy, and the seizure reduction occurred in a time-dependent manner. Moreover, patients with West syndrome may get the most benefits.     

Vagus nerve stimulation therapy for treatment of drug-resistant epilepsy and depression

Vagal nerve stimulation therapy is a new adjunctive treatment for drug-resistant epilepsy and depression. It consists of a pulse generator that transmits impulses to the left vagus nerve via an implantable electrode and can be performed by surgeons familiar with the anatomy of the cervical vagus nerve. The minimum age for vagal nerve stimulation therapy for epilepsy is 12 years, and for depression, 18 years. Hoarseness and cough are the most common side effects. Response rates to vagal nerve stimulation therapy vary and depend on several other factors. If used as adjunctive therapy, vagal nerve stimulation has shown better control of seizures or depression at smaller doses of antiepileptic or antidepressive medications and also results in decreased dose-dependent side effects. Vagal nerve stimulation therapy appears safe as an adjunctive treatment for drug-resistant epilepsy and depression. Long-term data are needed to better define its ultimate role in various subsets of patients.     

Peripheral neurostimulation for the treatment of chronic,disabling transformed migraine

BACKGROUND: Up to 5% of the general population suffers from transformed migraine. This study analyzes clinical responses of transformed migraine to cervical peripheral nerve stimulation. METHODS: Headache frequency, severity, and disability (Migraine Disability Assessment [MIDAS] scores) were independently measured in an uncontrolled consecutive case series of 25 patients with transformed migraine implanted with C1 through C3 peripheral nerve stimulation. All patients met International Headache Society (IHS) criteria for episodic migraine, as well as suggested criteria for transformed migraine, and had been refractory to conventional treatment for at least 6 months. Responses to C1 through C3 peripheral nerve stimulation were recorded. RESULTS: Prior to stimulation, all patients experienced severe disability (grade IV on the MIDAS) with 75.56 headache days (average severity, 9.32; average MIDAS score, 121) over a 3-month period. Following stimulation, 15 patients reported little or no disability (grade I), 1 reported mild disability (grade II), 4 reported moderate disability (grade III), and 5 continued with severe disability (grade IV), with 37.45 headache days (average severity, 5.72; average MIDAS score, 15). The average improvement in the MIDAS score was 88.7%, with all patients reporting their headaches well controlled after stimulation. CONCLUSIONS: These results raise the possibility that C1 through C3 peripheral nerve stimulation can help improve transformed migraine symptoms and disability. A controlled study is required to confirm these results.     

后路全椎板切除治疗42例椎管内神经鞘瘤的诊疗分析

目的：探讨经后路全椎板切除治疗椎管内神经鞘瘤的临床疗效。方法对2009年1月至2012年6月共42例椎管内神经鞘瘤患者行后路全椎板切除入路摘除椎管内神经鞘瘤。其中男18例,女24例;年龄36~72岁,平均53岁。病程2个月~3年,平均10.6个月。肿瘤发病节段：颈段3例,胸段25例,腰段12例,骶段2例。神经损害按Frankel分级：B级2例,C级8例,D级20例,E级12例。术后定期门诊随访,同时电话或门诊进行〉12个月的末次随访。观察临床疗效,复查X线片及MRI,观测内固定的稳定情况及肿瘤有无复发。结果42例患者肿瘤术中完整切除,术后病理证实神经鞘瘤。手术时间1.5~3.5h,平均2.0h,术中出血量30~200ml。术后8例患者出现不同程度的脑脊液漏,予绝对卧床、局部加压、缝合处理后,脑脊液漏停止。2例胸段载瘤神经根切除后出现胸壁感觉麻木异常,给予甲钴胺及加巴喷汀处理口服处理后,症状2~4个月内逐渐消失。获随访患者39例,平均随访时间12~35个月,平均22个月。随访期内,39例患者MRI复查无肿瘤复发,内固定位置好,无松动断裂现象。术后神经功能恢复Frankel分级,D级9例,E级30例。结论经后路全椎板切除治疗椎管内神经鞘瘤能获得较好的临床疗效,MRI在肿瘤的诊治中起重要作用,脑脊液漏及载瘤神经根切除是防止复发和手术成功的关键。     

Current problems in epilepsy]

Three new aspects of epilepsy are discussed: the mesiotemporal syndrome, vagus nerve stimulation, and epilepsy and driving fitness. In recent years mesiotemporal epilepsy has been recognised as the most frequent epileptic syndrome in adults. The main clinical features are febrile convulsions during childhood, followed by characteristic focal seizures in the second decade of life. The typical seizure is characterised by an aura, followed by loss of consciousness, with motor phenomena and automatisms followed by longer periods of postictal confusion. Atrophy of the hippocampus and sclerosis are observed in MRI. The syndrome is frequently drug resistant, however, 80% of the patients are free of seizure after surgical treatment. Vagus nerve stimulation is a new option in the treatment of patients with drug resistant epilepsy (partial seizures with or without secondary generalization, Lennox-Gastaut syndrome), especially when surgical intervention is not indicated. Worldwide a total of more than 4000 patients have been treated. More than 50% reduction in the frequency of seizures can be obtained in 35-40% of drug resistant patients. Complications are rare. Finally, the issue of driving fitness and epilepsy as well as provoked seizures are discussed. The current regulations and laws are taken into consideration and revised regulations for Austria are suggested.     

加压包扎联合微波治疗腰椎手术后脑脊液漏

目的探讨缝合加压包扎联合微波治疗腰椎手术后并发脑脊液漏的临床效果。方法 27例腰椎术后并发脑脊液漏的患者分为3组进行治疗,A组(10例)进行单纯引流,B组(7例)行缝合后加压包扎,C组(10例)行缝合加压包扎缝合联合微波局部伤口治疗,记录治疗前脑脊液日平均引流量、治疗后脑脊液漏停止时间、伤口愈合级别、脑脊液漏相关并发症的发生,并进行统计分析。随访4个月至5年。结果三组患者治疗前脑脊液平均日引流量分别为(378.5±53.0)ml、(379±57.0)ml、(369±55.0)ml,无统计学差异(P>0.05);三组脑脊液漏停止时间分别为(12.4±5.0)d、(7.9±2.2)d、(6.0±1.4)d,三组间差异有统计学意义(P<0.05);A组切口乙级愈合8例,丙级愈合2例,B组、C组均为乙级愈合。三组中无中枢神经系统感染。随访4个月至5年,A组有1例出现硬膜外脑脊液囊肿。结论加压包扎联合微波是治疗腰椎术后脑脊液漏的有效方法。     

Practical issues and concepts in vagus nerve stimulation: a nursing review.

Estimates of epilepsy incidence among the U.S. population range between 0.5% and 1%. The most common type of seizure in adult patients is partial onset. Approximately 20% of these patients are refractory to antiepileptic drug therapy and experience intolerable side effects such as confusion, dizziness, weight gain, lethargy, and ataxia. The ketogenic diet appears to be beneficial for children but is not considered a standard option for adults. Epilepsy surgery can be an option for many and may offer control or a reduction in seizures. However, many patients are opposed to cranial surgery or may not tolerate the ketogenic diet. Recent advances in biomedical technology and perfection in surgical techniques have shown vagus nerve stimulation (VNS) using the Neuro Cybernetic Prosthesis (NCP) system is an effective new treatment option in reducing seizure frequency. On July 16, 1997, the U.S. Food and Drug Administration (FDA) approved the use of the NCP for vagus nerve stimulation, as an adjunctive treatment for refractory partial onset seizures in adults and adolescents over 12 years of age. Murphy et al. and Wheless have reported similar results in children younger than 12 years. VNS represents the first therapy using a medical device approved by the FDA for the treatment of refractory seizures. An estimated 10,000 patients have been implanted with the device.     

适宜的迷走神经刺激参数对癫痫的控制作用

背景迷走神经刺激参数直接关系到迷走神经刺激的抗痫效果及患者使用的安全性,选择适宜的迷走神经刺激参数组合是实现迷走神经刺激抗痫作用的关键因素.目的观察电刺激参数包括输出电流、波宽、频率、开启时间、关闭时间、何时启动等在迷走神经刺激控制癫痫中的作用.设计单一样本实验.单位首都医科大学基础医学院神经生物学系.材料实验于2000-09/2002-09在首都医科大学基础医学院神经生物学系电生理实验室完成.选择健康成年Wistar大鼠36只.方法36只大鼠经海人藻酸复制大鼠癫痫模型,通过采用不同的迷走神经刺激参数组合,以大鼠行为学、心电图、皮层电图、海马神经元放电活动为观测指标,观察迷走神经刺激参数在控制致痫大鼠中的作用,并从中筛选适宜的刺激参数组合.主要观察指标①海人藻酸致痫效应.②迷走神经刺激参数组合及其抗痫效应.结果36只大鼠均进入结果分析.①迷走神经刺激的抗痫效应的观察主要在痫性发作4 h以内.②当波宽为2 ms,刺激强度为3～3.5 mA,频率为30～35 Hz,开启1 min,关闭2 min时,连续刺激迷走神经50 min时,抗痫效果显著,痫性皮层电图的发作时间明显缩短,严重程度显著降低;致痫大鼠海马CA1区神经元暴发性放电频率降低(P＜0.05).结论在保证受试者心电活动正常的前提下,能有效控制痫性发作的最小刺激参数组合为最适参数组合,且对心脏功能没有影响.     

迷走神经刺激治疗癫痫的实验和临床研究

目的通过动物实验,探讨迷走神经刺激治疗癫痫的有效性和最佳刺激参数,并对临床上癫痫持续状态病人进行疗效研究。方法应用士的宁制成动物癫痫模型,手术后直接刺激左侧迷走神经,应用不同的刺激参数组合进行刺激。对临床上癫痫持续状态的病人,经皮间接刺激迷走神经进行疗效观察。结果应用波宽２ｍｓ、频率１００Ｈｚ、电压１０Ｖ的组合参数刺激,全部实验动物的强直性发作立刻得到控制、痫样放电立即消失,脑电图恢复正常。选择病人可以耐受的电压幅度连续电脉冲刺激左侧颈部迷走神经体表投影区,进行经皮间接刺激治疗不同类型癫痫持续状态,结果完全控制率为８３．３％。有效率达１００％。结论刺激左侧迷走神经治疗癫痫和经皮刺激迷走神经治疗癫痫持续状态有效,但刺激参数至关重要。