Comparison of clinical effects of STN-DBS in treatment of Parkinson's disease under local anesthesia and general anesthesia
Objective To compare the clinical effects of subthalamic nucleus deep brain stimulation(STN-DBS)under local anesthesia and general anesthesia in the treatment of Parkinson's disease.Methods Sixty-three patients with Parkinson's disease were selected,30 patients were treated with STN-DBS under local anesthesia(local anesthesia group)and 33 patients were treated with STN-DBS under general anesthesia(general anesthesia group).The Unified Parkinson's Disease Rating Scale(UPDRS-Ⅲ)was used to assess motor function before treatment and 3 months after treatment.STN discharge frequency was recorded by microelectrode during operation.The relative position of STN and microelectrode was determined according to the discharge activity,and the positioning record length was calculated.After operation,magnetic resonance imaging was performed to explore the planned position coordinates and the actual implantation position of the electrode,and the coordinate errors were calculated.The Montreal Cognitive Assessment Scale(MoCA)was used to assess cognitive function before treatment and 3 months after treatment.Standing and decumbent blood pressure,pulse index(PI),median cerebral artery flow rate(Vm)were measured,and the mean arterial pressure difference(ΔMAP),PI difference(ΔPI),and Vm difference(ΔVm)were calculated.Perioperative anesthesia,stimulation,and hardware-related complications were recorded.Results The UPDRS-Ⅲ scores in the opening and closing periods after treatment were lower than those before treatment(all P＜0.05),and there was no significant difference in the UPDRS-Ⅲ scores in the opening and closing periods between the two groups(P＞0.05).STN discharge frequency and positioning record length in the general anesthesia group were lower than those in the local anesthesia group(both P＜0.05),but there was no signifi-cant difference in coordinate error between the two groups(P＞0.05).The scores of all dimensional MoCA after treatment were higher than those before treatment(all P＜0.05),and there were no statistically significant difference in the scores of all dimensions of MoCA between two groups after treatment(all P＞0.05).After treatment,ΔMAP,ΔPI and ΔVm in local anesthesia group were lower than those before treatment(all P＜0.05),and there were no significant differences in ΔMAP,ΔPI or ΔVm in general anesthesia group before and after treatment(all P＞0.05).After treatment,ΔMAP,ΔPI and ΔVm in the general anesthesia group were higher than those in the local anesthesia group(all P＜0.05).There were 2 cases of intracerebral hemorrhage in the local anesthesia group on the day of operation,which improved after conservative treat-ment,and no other anesthesia,stimulation or hardware-related complications occurred in both groups.Conclusion The clinical effects of STN-DBS under general anesthesia and local anesthesia on motor function and cognitive function of Par-kinson's disease patients are similar,but general anesthesia is conducive to the stability of cerebral blood flow autoregula-tion function and is conducive to accurate target location.
Parkinson's diseasedeep brain stimulation of subthalamic nucleuslocal anesthesiageneral anesthe-siaclinical effect
国家科技期刊平台
NSTL
万方数据
维普
