脑深部电刺激治疗帕金森病的手术配合

目的探讨脑深部电刺激治疗帕金森病的手术配合要点。方法总结20例帕金森病患者行脑深部电刺激治疗手术配合的护理经验。结果 20例患者共植入38根电极,手术过程顺利,患者临床症状均明显改善;无1例发生颅内血肿、感染、永久神经系统功能障碍和护理并发症。结论熟知手术器械性能,做好术前准备和术中默契的配合对保证手术的顺利进行具有重要的意义。     

脑深部电刺激治疗帕金森病患者的护理配合

目的：探讨脑深部电刺激（ DBS）治疗帕金森病（ PD）患者手术配合的要点,以期提高临床疗效,减少并发症。方法对2011年3月至2012年10月行DBS手术的187例帕金森病患者,进行缜密、细致的手术配合,并对部分手术方法进行改进。结果187例患者共植入325侧电极,单侧49例,双侧138例,全部患者术后均无颅内血肿和永久神经系统并发症出现。187例患者随访3～27个月,开机不服药和开机服药患者的UPDRSⅢ评分改善率分别为51％和63％,与术前相比,患者术后服用多巴胺类药物的剂量明显减少,平均减少62％。结论 DBS是治疗PD的有效手段。周到细致的手术护理配合对DBS治疗帕金森病的疗效提高具有重要作用。     

脑深部电刺激术治疗帕金森病病人的手术全期护理

[目的]总结脑深部电刺激术(DBS)治疗帕金森病病人的手术全期护理。[方法]对29例帕金森病人行DBS治疗,加强全面细致的手术全期护理,包括术前专科化访视、术中手术配合及术后回访等,以促进病人的全面康复。[结果]29例病人术后肢体运动障碍均得到不同程度改善,无颅内出血、感染等并发症的发生。[结论]加强DBS治疗帕金森病病人的护理是手术成功的保证。     

脑深部电刺激治疗帕金森病的围手术期护理

目的 探讨脑深部电刺激（DBS）治疗帕金森病的护理方法及效果.方法 对我院2006年8月至2008年11月脑深部电刺激治疗的12例原发性帕金森病患者进行严谨的围手术期护理,重点加强患者的心理护理和知识宣教,严密观察病情,积极防范并发症的发生.结果 12例共植入22根电极（单侧2例,双侧10例）,刺激电极植入靶点均为丘脑底核（STN）,全部术后无颅内血肿出现,无感染及永久神经系统并发症,无刺激相关的不良反应;12例患者随访时间2～28个月,术后6个月UPDRSⅢ评分在开机不服药和开机服药的改善率分别是50%和67%.结论 周到细致的围手术期护理是STN-DBS治疗帕金森病良好疗效的保障.     

脑深部电刺激治疗帕金森病的护理

目的 探讨脑深部电刺激(Deep brain stimulation,DBS)治疗帕金森病围手术期配合和护理要点.方法 分析我院2006年8月～2010年9月脑深部电刺激治疗的21例原发性帕金森病患者的临床护理资料,在护理过程中,重点关注病人术前心理护理和宣教、术后做好病情观察、并发症的观察和护理、注意事项的宣教等.结...     

脑深部刺激治疗帕金森病手术并发症的观察与护理

目的 总结脑深部刺激治疗帕金森病手术并发症的观察与护理.方法 对自2000年1月-2004年3月住院帕金森病患者63例,手术采用磁共振扫描结合微电极记录技术进行靶点定位,刺激靶点为丘脑底核(ST)62例,丘脑腹中间核(Vim)1例,双侧30例,单侧33例,术后随访3个月～4年,平均7.3个月,进行并发症观察与护理.结果 本组手术病人2例症状控制不佳,经电极重新调整放置,症状控制理想.剌激电极与皮下导线连接处头皮切口破溃1例,胸部脉冲发生器植入处皮下感染1例,经局部穿刺抽液好转,记忆力轻度减退2例,情绪改变7例,身体异动19例,睁眼困难1例,但未发生明显的致残性永久并发症.结论 手术病人术前采取有针对性的心理护理,术中术后严密病情观察,注重肢体的功能锻炼,并给予正确的出院指导,可促进患者的康复过程.     

立体定向脑深部电极植入治疗帕金森病的手术配合

总结10例立体定向脑深部电极植入的手术配合要点,包括术前心理护理,术前准备,术中配合,术后随访等,认为充分的术前准备,熟练的手术配合是手术成功的关键。     

脑深部电刺激术治疗帕金森病患者的围手术期护理

帕金森病(Parkirlsorl's disease,PD)又称震颤麻痹,是一种中枢神经系统退行性疾病.患者年龄均偏大,以50～60岁为发病高峰年龄群[1].PD以静止性震颤、肌强直、运动迟缓、姿势步态异常等运动症状为典型临床特征[2].脑深部电刺激(DBS)是一种能有效抑制PD症状的微创性的、可逆的、可调节的神经外科技术[3].我科2003年12月～2012年1月利用DBS术治疗PD患者12例,获得良好效果,现报告如下.     

脑深部电刺激术手术护理配合流程构建

总结80例帕金森病(PD)患者实施脑深部电刺激(DBS)手术的护理配合要点。目的:探讨手术配合要点,制定围手术期护理方案,优化传统手术护理配合方法,减少手术并发症,缩短手术时间,并对部分护理方法进行改进,旨在建立一套统一的标准化围手术期护理配合流程,提高临床疗效。方法:2015年1月至2017年7月行DBS手术的80例帕金森病患者进行细致、缜密的手术护理配合。采取术前评估制定帕金森患者术前评估表,术中密切配合并注意患者的安全管理,时刻关注患者肢体变化,及时做出反应,术后及时的回访。结果:80例患者共植入155侧电极,5例单侧,75例双侧,其中1例患者术后出现颅内血肿,经对症治疗后血肿消失,其余患者无颅内血肿、永久神经系统以及与手术相关并发症出现。结论:本组80例患者,术后早期均有不同程度的临床症状改善,专科护士配合,流程的优化提高了手术配合的熟练度,手术时间较前有所缩短,术者满意度提高。标准化围手术期护理配合流程对DBS治疗PD的疗效提高具有重要作用。     

深部脑刺激电极埋置术治疗帕金森病的护理

帕金森病(Parkinson’s disease,PD)是发生于中老年人的以震颤、僵直和运动迟缓为主要症状的中枢神经系统疾病。深部脑刺激电极埋置术(deep brain stimulation,DBS)是继射频热凝毁损术之后,治疗PD的一种新的微创手术,是在脑深部特定的神经核团置入电极,通过释放高频电刺激,抑制神经元异常电活动,而发挥治疗作用,能明显改善PD症状,提高患生活质量。1999年10月至2003年5月,我科采用立体定向技术行DBS12例,效果满意,现将本组患的护理介绍如下：     

深部脑刺激电极埋置术对帕金森病僵硬－震颤效果研究

目的探讨深部脑刺激电极埋置术治疗帕金森病的治疗效果。方法使用微电极导向立体定向技术,在丘脑底核埋置深部电极,通过可控性电刺激治疗帕金森病的僵硬－震颤症状。结果电刺激治疗帕金森病能有效控制患者的僵硬－震颤症状,能消除由药物引起的开－关现象和症状波动,服用的左旋多巴类药物可一定程度的减量。术中及术后无明显的并发症。结论丘脑底核放置深部脑刺激电极,通过适当强度的电刺激,能使症状明显改善,且并发症少,与损毁术相比相对安全,但价格较昂贵。     

Pathways of Translation: Deep Brain Stimulation

Electrical stimulation of the brain has a 2000 year history. Deep brain stimulation (DBS), one form of neurostimulation, is a functional neurosurgical approach in which a high‐frequency electrical current stimulates targeted brain structures for therapeutic benefit. It is an effective treatment for certain neuropathologic movement disorders and an emerging therapy for psychiatric conditions and epilepsy. Its translational journey did not follow the typical bench‐to‐bedside path, but rather reversed the process. The shift from ancient and medieval folkloric remedy to accepted medical practice began with independent discoveries about electricity during the 19th century and was fostered by technological advances of the 20th. In this paper, we review that journey and discuss how the quest to expand its applications and improve outcomes is taking DBS from the bedside back to the bench.     

Deep Brain Stimulation: Overview And Update

Objective: To summarize the techniques for physiological localization that contribute to increased accuracy in the surgical treatment of movement disorders. Methods: Initial targeting through imaging referenced to stereotactic atlas are confirmed through physiological localization. Spontaneous recording, elicited recording, evoked potentials and stimulation provided physiological localization for target confirmation in the placement of lesions or DBS. Results: Imaging and stereotactic techniques produce inaccuracy that may be address by physiological localization. Microelectrode recording from basal ganglia and thalamic sites provides signature neuronal patterns to confirm and guide the trajectory. Spontaneous and elicited neuronal response are recorded from microelectrodes. Conclusions: Accuracy of movement disorders surgery is enhance through use of physiological localization. A multimodality approach provides techniques that allow localization in a variety of patient and environmental conditions.     

表没食子儿茶素没食子酸酯对MPTP致多巴胺能神经元损伤的保护作用

目的研究表没食子儿茶素没食子酸酯(EGCG)对1-甲基-4-苯基-1,2,3,6-四氢吡啶(MPTP)致帕金森病模型小鼠多巴胺能神经元的保护作用。方法32只雄性C57BL/6小鼠随机分为4组：假手术组腹腔注射等量生理盐水,模型组腹腔注射4次MPTP(16 mg/kg,间隔2 h),EGCG治疗组为MPTP+EGCG(5 mg/kg)组,EGCG正常给药组不做任何处理,每日给予5 mg/kg EGCG。连续给药3周后检测行为学指标,黑质酪氨酸羟化酶(TH)免疫组化染色及高效液相色谱-电化学法测定纹状体内多巴胺及其代谢产物浓度。结果模型组5 min内的自发运动次数(71.4±14.0)下降,而EGCG治疗组自发运动次数(87.9±10.7)提高(P<0.05)。与模型组转杆停留时间(73.5±24.9) s相比,EGCG治疗组转杆停留时间(118.6±31.2) s延长(P<0.05)。形态学结果显示,EGCG治疗组黑质TH阳性神经元与模型组相比,数量明显增多。模型组纹状体内多巴胺(DA)及其代谢产物3,4-双羟苯乙酸(DOPAC)和高香草酸(HVA)浓度显著降低,而EGCG治疗组DA、DOPAC和HVA浓度虽有一定程度升高,但无统计学差异。结论EGCG改善MPTP致帕金森病模型小鼠的运动能力下降,对黑质多巴胺神经元有保护作用。     

Deep Brain Stimulation as a Treatment for Neuropathic Pain: A Longitudinal Study Addressing Neuropsychological Outcomes

Deep brain stimulation (DBS) of the periventricular/periaqueductal gray area and sensory thalamus can reduce pain intensity in patients with neuropathic pain. However, little is known about its impact on quality of life, emotional well-being, and cognition. This study followed up 18 patients who had received DBS for neuropathic pain. Each participant had previously undergone psychometric evaluation of each of the above areas as part of a routine presurgical neuropsychological assessment. Commensurate measures were employed at a follow-up assessment at least 6 months postsurgery. DBS significantly improved mood, anxiety, and aspects of quality of life. Improvements correlated with reduced pain severity. However, the sample continued to show impairments in most areas when compared against normative data published on nonclinical samples. There was little change in general cognitive functioning, aside from deterioration in spatial working memory. However, improvements in pain severity were associated with less improvement (and even deterioration) on measures of executive cognitive functioning. Improvements in emotional well-being also were correlated with changes in cognition. These results suggest that DBS of the periventricular/periaqueductal gray and/or sensory thalamus improves quality of life and emotional well-being in sufferers, although there is some indication of executive dysfunction, particularly among those reporting greatest pain alleviation.PerspectiveThis article examines the neuropsychological outcomes of DBS surgery as a treatment for neuropathic pain. This intervention was found to improve pain severity, emotional well-being, and quality of life, although such benefits may be accompanied by reduced ability on tasks measuring executive functioning.