丘脑底核脑深部电刺激术联合药物治疗帕金森病的 疗效及对血尿酸水平的影响

目的:研究丘脑底核脑深部电刺激术联合药物治疗帕金森病(PD)的疗效及对血尿酸水平的影响。方法:选择2014年6月至2017年6月唐都医院神经外科收治的89例PD患者,随机分为观察组45例和对照组44例。对照组实施常规药物治疗,观察组实施常规药物治疗联合丘脑底核脑深部电刺激术治疗。比较2组治疗前和治疗后6、12周帕金森统一评分量表(UPDRS)评分和临床疗效、用WHO-QOL-2评分量表评定的生活质量及血尿酸水平。结果:治疗12周后,观察组有效率为93.33%(42/45),明显高于对照组的77.27%(34/44)(P0.05);观察组UPDRS评分与治疗前及对照组比较明显降低(P0.05),生理、环境、独立性、社会关系和心理评分与治疗前和对照组比较均明显升高(P0.05);血尿酸水平与治疗前和对照组比较均明显降低(P0.05)。结论:与常规药物治疗比较,丘脑底核脑深部电刺激术联合药物治疗可显著改善PD患者的运动功能和生活质量,提高临床疗效,降低血尿酸水平。     

双侧丘脑底核电刺激对原发性帕金森病患者运动功能的改善作用

目的:评价对原发性帕金森病患者实施双侧丘脑底核脑深部电刺激治疗后运动功能的改善情况,以及对左旋多巴用量的影响。方法:选择2003-09/2004-11在解放军第三军医大学新桥医院神经外科行双侧丘脑底核慢性高频脑深部电刺激的帕金森病患者6例。采用磁共振导向立体定向方法,将刺激电极分别植入双侧丘脑底核,同期植入刺激发生器。术后1个月用程控计算机在体外调整刺激参数,以达到最佳疗效。术后3个月分别在开、关状态进行帕金森病联合评分,日常生活活动评分评估肢体震颤,肌强直,运动减少等症状的改善。并对术前术后左旋多巴制剂用量进行了比较。结果:6例患者全部进入结果分析。①6例患者术后均获得了显著的疗效,震颤完全消失,肌强直、步态、姿势障碍以及药物所致的并发症明显改善。②药物开状态时(指药物开始起作用时,患者活动自如)日常生活活动评分、统一帕金森病评定量表总评分、运动评分:慢性高频脑深部电刺激术后刺激器开状态均明显优于刺激器关状态[(7.9±3.2),(23.5±5.3)分;(37.8±3.4),(45.2±5.4)分;(30.5±3.1),(42.1±5.4)分,(P<0.05～0.01)]。药物关状态时日常生活活动评分、统一帕金森病评定量表总评分、运动评分:慢性高频脑深部电刺激术后刺激器开状态均明显优于刺激器关状态[(8.6±2.8),(35.3±4.8)分;(42.6±4.9),(78.4±7.7)分;(35.2±4.7),(70.7±6.8)分,(P<0.05～0.01)]。③左旋多巴制剂的用量:慢性高频脑深部电刺激后3个月时明显低于刺激前[(346.3±182.8)mg/d,(880.6±254.9)mg/d,(P<0.01)]。结论:慢性高频脑深部电刺激治疗帕金森病,可明显控制肢体震颤,肌张力障碍、步态、姿势等运动障碍,减少患者左旋多巴的用量。     

国内脑深部丘脑底核电刺激术治疗帕金森病的meta分析

目的应用meta分析方法,综合评价丘脑底核脑深部电刺激术(STN-DBS)治疗帕金森病(PD)的临床疗效。方法检索国内关于脑深部电刺激术(DBS)治疗PD的研究,对符合纳入标准的文献进行meta分析。结果共纳入9篇文献,总样本量为226例,其中"药物关"状态下对统一帕金森病评分量表(UPDRS)Ⅲ进行评分者226例,对UPDRSⅡ进行评分者159例。"药物开"状态下对UPDRSⅢ进行评分者156例,对UPDRSⅡ进行评分者102例。4种情况下STN-DBS前后合并指标加权均数差(WMD)及其95%CI分别为25.85(16.82~34.88)、17.28(12.37~22.18)、4.29(2.56~6.02)、3.03(0.57~5.48)。meta分析合并结果显示,"药物开"和"药物关"状态下,STN-DBS手术后UPDRSⅢ评分和UPDRSⅡ评分均比手术前显著降低,差异有统计学意义(P0.05)。结论STN-DBS用于治疗PD,能有效改善运动不能、肌肉僵直、步态不稳、姿势平衡性和肌张力障碍、异动症等。     

双侧丘脑底核电刺激对原发性帕金森病患者运动功能的改善作用

目的：评价对原发性帕金森病患者实施双侧丘脑底核脑深部电刺激治疗后运动功能的改善情况，以及对左旋多巴用量的影响。方法：选择2003—09／2004—11在解放军第三军医大学新桥医院神经外科行双侧丘脑底核慢性高频脑深部电刺激的帕金森病患者6例。采用磁共振导向立体定向方法，将刺激电极分别植入双侧丘脑底核，同期植入刺激发生器。术后1个月用程控计算机在体外调整刺激参数，以达到最佳疗效。术后3个月分别在开、关状态进行帕金森病联合评分，日常生活活动评分评估肢体震颤，肌强直，运动减少等症状的改善。并对术前术后左旋多巴制剂用量进行了比较。结果：6例患者全部进入结果分析。①6例患者术后均获得了显著的疗效，震颤完全消失，肌强直、步态、姿势障碍以及药物所致的并发症明显改善。②药物开状态时（指药物开始起作用时，患者活动自如）日常生活活动评分、统一帕金森病评定量表总评分、运动评分：慢性高频脑深部电刺激术后刺激器开状态均明显优于刺激器关状态[（7．9&;#177;3．2），（23．5&;#177;5.3）分；（37．8&;#177;3．4），（45．2&;#177;5.4）分；（30．5&;#177;3．1），（42．1&;#177;5.4）分，（P〈0．05-0．01）]。药物关状态时日常生活活动评分、统一帕金森病评定量表总评分、运动评分：慢性高频脑深部电刺激术后刺激器开状态均明显优于刺激器关状态[（8．6&;#177;2．8），（35．3&;#177;4．8）分；（42．6&;#177;4．9），（78．4&;#177;7．7）分；（35．2&;#177;4．7），（70．7&;#177;6．8）分，（P〈0．05-0、01）]。③左旋多巴制剂的用量：慢性高频脑深部电刺激后3个月时明显低于刺激前[（346．3&;#177;182．8）mg／d，（880．6&;#177;254．9）mg／d，（P〈0．01）]。结论：慢性高频脑深部电刺激治疗帕金森病，可明显控制肢体震颤，肌张力障碍、步态、姿势等运动障碍．减少患者左旋多巴的用量。     

深部脑电刺激治疗帕金森病的FDGPET研究

目的研究双侧丘脑底核慢性电刺激术对晚期帕金森病患者脑局部糖代谢的影响及作用机制.方法对7例进行双侧STN DBS的晚期帕金森病患者,在术前和术后1个月电刺激条件下,分别进行18F-脱氧葡萄糖(18F-FDG)PET显像和UPDRS评分,通过SPM进行数据分析.结果 7例患者临床症状明显改善,同时FDG PET显像提示双侧豆状核、脑干、顶枕部、运动前区(BA6)及扣带回的脑代谢增加,而前额叶底部及海马的脑代谢减少(P<0.05).结论双侧STN DBS可使PD患者临床症状改善.FDG PET可作为PD进行STN治疗适应证选择的方法之一.     

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.     

急性阶梯式左旋多巴试验预测脑深部电刺激术治疗帕金森病疗效的前瞻性研究

目的 评价急性阶梯式左旋多巴试验对脑深部电刺激术治疗帕金森病疗效的预测价值.方法 65例帕金森病患者在筛选过程中进行了急性阶梯式左旋多巴负荷试验(左旋多巴/苄丝肼剂量依次为100/25 mg、150/37.5 mg、200/50 mg和300/75mg),然后接受双侧丘脑底核-脑深部电刺激器(STN-DBS)植入术,随访24个月.将急性左旋多巴负荷试验的结果与24个月后的脑深部电刺激术疗效进行对照和一致性检验.结果 给予左旋多巴/苄丝肼150/37.5 mg,200/50 mg和300/75 mg的试验结果与STN-DBS疗效的一致性高,Kappa值依次为0.373、0.642和0.849(P<0.01).给予左旋多巴/苄丝肼100/25 mg进行试验结果与STN-DBS疗效的一致性低,Kappa值为0.221(P>0.05).结论 急性阶梯式左旋多巴负荷试验可以准确预测脑深部电刺激术治疗帕金森病的远期疗效,可以用于筛选适合脑深部电刺激术治疗的帕金森病患者.     

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。     

原发性帕金森病应用脑深部电刺激术与药物治疗的效果研究

研究原发性帕金森病应用脑深部电刺激术与药物治疗的效果。选择2014年1月~2016年12月我院收治的80例帕金森病患者作为试验对象,根据双盲法将80例患者分成两组,取其中40例帕金森病患者仅应用药物治疗设作对照组,另外40例帕金森病患者在对照组治疗基础上应用脑深部电刺激术治疗设作观察组,根据帕金森病评价量表(UPDRS)与帕金森病生活质量量表(PDQUALIF)对两组患者治疗效果进行评价。治疗后,两组UPDRS评分、PDQUALIF评分优于治疗前(P<0.05);观察组UPDRS评分、PDQUALIF评分明显优于对照组(P<0.05);观察组总有效率97.5%,对照组总有效率77.5%,对比两组治疗效果,观察组有效率更为理想(P<0.05)。原发性帕金森病患者应用脑深部电刺激术与药物治疗可以明显改善患者症状,提高临床治疗效果和生活质量,值得推广应用。     

立体定向核团毁损术治疗帕金森病的疗效观察

目的分析电极引导下立体定向核团毁损术治疗帕金森病的临床治疗效果。方法对82例接受电极引导下立体定向核团毁损术治疗的帕金森病患者进行随访和神经功能评估,手术治疗前、手术后1周、1个月、6个月、12个月、24个月不同服药状态下统一帕金森病量表(UPDRS)评分,采用Wilcoxcon检验比较手术后不同时间点UPDRS运动评分,以及与手术前的评分的差异。结果立体定向核团毁损术后6个月、12个月、24的随访显示:毁损术不仅能改善术前帕金森病患者的UPDRS评分,UPDRS评分逐渐减低,而且减轻了左旋多巴诱发的运动波动。患者术后口服抗帕金森病类药物用量较术前明显减少。核团毁损术永久性并发症的发生率约为1.2%(1/82),总体并发症发生率约为13.4%(11/82)。结论立体定向核团毁损术是中晚期帕金森病安全、有效的治疗方法,能改善帕金森病患者的UPDRS评分,减轻左旋多巴诱发的运动波动,但精确定位是手术成功的关键。     

Sequential changes in motor speech across a levodopa cycle in advanced Parkinson's disease

Previous research has indicated that in Parkinson's disease (PD) some motor speech characteristics are changed by levodopa administration, while others are not. In advanced PD, the time course of these changes and the correlations with motor performance have not been sufficiently investigated. The purpose was to investigate the sequential changes of respiratory, articulatory, and phonatory speech characteristics across a levodopa drug cycle, using spirometry, acoustic, and motor speech analysis. Seven patients with advanced PD were included. All patients were evaluated sequentually at 15 minute intervals before and following levodopa intake. Data were analysed using repeated measures ANOVA and non-parametric analysis. Significant changes were found in motor function, vital capacity, and standard deviation of the diadochokinetic period. A trend was present for shimmer and frequency of the first formant. Significant inter-individual differences in the sequential changes were demonstrated for nearly all evaluated parameters. The conclusion is that, in advanced PD, the evaluation of speech characteristics at one moment after levodopa administration is not representative of an entire drug cycle and that an individualized evaluation of an entire drug cycle is warranted before initiation of a speech-language pathology program.     

Subthalamic deep brain stimulation modulates small fiber-dependent sensory thresholds in Parkinson's disease

The effects of deep brain stimulation of the subthalamic nucleus on nonmotor symptoms of Parkinson's disease (PD) rarely have been investigated. Among these, sensory disturbances, including chronic pain (CP), are frequent in these patients. The aim of this study was to evaluate the changes induced by deep brain stimulation in the perception of sensory stimuli, either noxious or innocuous, mediated by small or large nerve fibers. Sensory detection and pain thresholds were assessed in 25 PD patients all in the off-medication condition with the stimulator turned on or off (on- and off-stimulation conditions, respectively). The relationship between the changes induced by surgery on quantitative sensory testing, spontaneous CP, and motor abilities were studied. Quantitative sensory test results obtained in PD patients were compared with those of age-matched healthy subjects. Chronic pain was present in 72% of patients before vs 36% after surgery (P=.019). Compared with healthy subjects, PD patients had an increased sensitivity to innocuous thermal stimuli and mechanical pain, but a reduced sensitivity to innocuous mechanical stimuli. In addition, they had an increased pain rating when painful thermal stimuli were applied, particularly in the off-stimulation condition. In the on-stimulation condition, there was an increased sensitivity to innocuous thermal stimuli but a reduced sensitivity to mechanical or thermal pain. Pain provoked by thermal stimuli was reduced when the stimulator was turned on. Motor improvement positively correlated with changes in warm detection and heat pain thresholds. Subthalamic nucleus deep brain stimulation contributes to relieve pain associated with PD and specifically modulates small fiber-mediated sensations.     

氟比洛芬酯联合舒芬太尼术后镇痛对结肠癌根治术患者GPⅡb/Ⅲa、GMP-140表达的影响

目的:血小板在肿瘤细胞转移与血栓形成过程中发挥着重要作用,本研究拟观察氟比洛芬酯联合舒芬太尼术后镇痛对结肠癌根治术患者血小板GPⅡb/Ⅲa、GMP-140表达的影响.方法:40例全麻下接受结肠癌根治术的患者随机分为2组,每组20例:氟比洛芬酯联合舒芬太尼镇痛组(FS组);舒芬太尼镇痛组(S组).另选15例健康体检者作为正常对照组.采用视觉模拟评分法评价两组患者术后1,4,8,12,24和48 h镇痛的效果.采用流式细胞仪检测麻醉前(T_0)、手术开始后2h(T_1)、手术结束后4h(T_2)、手术结束后24 h(T_3)、手术结束后48 h(T_4)时GPⅡb/Ⅲa与GMP-140的表达.结果:两组患者术后镇痛效果无统计学差异(P＞0.05).与T0比较,FS组在T1时的GPⅡb/Ⅲa、GMP-140表达明显增加(P＜0.05);FS组在T_2、T_3、T_4时的GPⅡb/Ⅲa、GMP-140表达明显低于S组(P＜0.05);与T0比较,S组在T_1、T_2、T_3时的GPⅡb/Ⅲa和GMP-140表达明显增加(P＜0.05).结论:术后采用氟比洛芬酯联合舒芬太尼镇痛能有效减轻结肠癌根治术患者的术后疼痛及抑制血小板GPⅡb/Ⅲa复合物与GMP-140的过度表达.     

氯胺酮对神经病理性疼痛大鼠脊髓P2X_4受体mRNA表达的影响

目的:研究氯胺酮对神经病理性疼痛大鼠脊髓P2X_4受体mRNA表达的影响.方法:雄性SD大鼠45只,体重180～220g,随机分为假手术组(S组)、对照组(C组)和氯胺酮Ⅰ、Ⅱ、Ⅲ组(KⅠ、Ⅱ、Ⅲ组),每组9只.S组大鼠仅分离坐骨神经但不结扎,其余组建立坐骨神经慢性压迫性损伤(CCI)模型,K Ⅰ、Ⅱ、Ⅲ组分别于CCI后3d开始至取材点每天腹腔注射氯胺酮5mg/kg、10mg/kg、20mg/kg;S组和C组注射相同体积的生理盐水.各组大鼠分别于术前1d,术后3d、7d、14d、21d测定大鼠机械性痛觉过敏(MWT)和热痛觉过敏(TWL).各组均分别于CCI术后7d、14d、21d取3只大鼠,测定痛阈后处死,取L_(4～5)脊髓组织,用逆转录PCR(RT-PCR)方法测定P2X_4受体mRNA表达水平.结果:与术前及S组比较,C组、K Ⅰ、Ⅱ、Ⅲ组术后3d开始热痛阈及机械痛阈显著降低(P＜0.05).与C组比较,K Ⅰ、Ⅱ、Ⅲ组术后7d,14d,21d热痛阈及机械痛阈显著升高(P＜0.05).与S组比较,C组、K Ⅰ、Ⅱ、Ⅲ组大鼠脊髓P2X_4受体表达在术后7d、14d、21d均显著增加(P＜0.05);与C组大鼠比较,K Ⅰ、Ⅱ、Ⅲ组脊髓P2X_4受体表达明显减少(P＜0.05).结论:腹腔注射氯胺酮可抑制慢性神经痛大鼠痛觉过敏,该作用可能是通过作用于P2X_4受体介导的.     

Free-living energy expenditure reduced after deep brain stimulation surgery for Parkinson's disease

Background: The clinical picture in Parkinson’s disease (PD) is characterized by bradykinesia, rigidity, resting tremor and postural instability. In advanced stages of the disease, many patients will experience reduced efficacy of medication with fluctuations in symptoms and dyskinesias. Surgical treatment with deep brain stimulation in the subthalamic nucleus (STN‐DBS) is now considered the gold standard in fluctuating PD. Many patients experience a gain of weight following the surgery. The aim of this study was to identify possible mechanisms, which may contribute to body weight gain in patients with PD following bilateral STN‐DBS surgery. Methods: Ten patients with PD were studied before bilateral STN‐DBS surgery, and seven patients were studied again 3 and 12 months postoperatively. Clinical examination and resting metabolic rate with and without medical treatment was measured before and after STN‐DBS. Furthermore, free‐living energy expenditure, body composition, energy intake, peak oxygen consumption, maximal workload and leisure time physical activity were measured before and 3 and 12 months after surgery. Results: The STN‐DBS operated patients had a significant weight gain of 4·7 ± 1·6 kg (mean ± SE) 12 months postoperatively, and the weight gain was in the fat mass. The free‐living energy expenditure decreased postoperatively 13 ± 4% even though the reported dietary intake was reduced. A decreased energy expenditure took place in the non‐resting energy expenditure. The reported daily leisure time activity, peak oxygen consumption and maximal workload were unchanged. Conclusion: The STN‐DBS operated patients have a significant postoperative weight gain, as a result of a decrease in free‐living energy expenditure concomitant with an insufficient decrease in energy intake.     

和络舒肝胶囊对慢性肝炎纤维化指标的影响

目的探讨中药和络舒肝胶囊对慢性肝炎患者血清ALT、CIV、HA、PCⅢ的影响。方法将237例慢性肝炎患者随机分为治疗组122例,对照组115例,两组患者均用护肝药、维生素等常规治疗方法,治疗组加服络舒肝胶囊6个月,分别于用药前及用药后第2月、第4月、第6月,检测血清中ALT、CIV、HA、PCⅢ的变化。结果治疗组与对照组相比用药后第2月ALT、CIV、HA、PCⅢ下降不明显（P〉0．05）,但第4月与第6月均有明显下降（P〈0．05）。结论中药和络舒肝胶囊有明显的降低血清ALT、CIV、HA、PCⅢ的作用,是治疗慢性肝炎,防止肝纤维化的有效药物。     

全髋关节置换术前综合性干预对术后康复的影响

目的 探讨全髋关节置换术前综合性干预对术后康复效果的影响.方法 选择择期行全髋关节置换手术的患者80例,用抽签法随机分为实验组和对照组(各40例).实验组术前接受心理干预、并掌握排尿功能及肢体功能康复训练方法,对照组术前只了解常规指导,2组术后的康复训练程序完全一致.比较术后心理状态、第一次排尿情况及术后第1、3个月末临床康复效果评价.结果 实验组术后心理状态明显优于对照组,差异有统计学意义(P＜0.05);患者第1次能自行排尿的情况明显优于对照组,差异有统计学意义(P＜0.01);实验组第4周末康复训练计划完成量多于对照组,差异有统计学意义(P＜0.05).术后第1,3个月时,实验组的置换髋关节功能评分分别显著高于对照组,2组间差异有统计学意义(P＜0.05). 结论术前综合干预,可提高术后肢体早期功能训练的效率,减少术后并发症,早日恢复肢体功能.