Neuromodulation:深部脑刺激治疗帕金森病的一些较少研究的方面:植入手术、住院治疗和死亡

2021-06-17 MedSci原创 MedSci原创

以丘脑底核(STN)或苍白球(GPi)为靶点的脑深部电刺激(DBS)可显著改善帕金森病(PD)患者的生活质量。据估计,全世界有超过15万帕金森病患者接受了这种疗法。这种疗法相对未被研究的是治疗本身(如

以丘脑底核(STN)或苍白球(GPi)为靶点的脑深部电刺激(DBS)可显著改善帕金森病(PD)患者的生活质量。据估计,全世界有超过15万帕金森病患者接受了这种疗法。这种疗法相对未被研究的是治疗本身(如编程和手术)带来的长期负担,以及这些患者在社区生活和生存的时间。然而,这些鲜为人知的研究方向是至关重要的,以了解临床决策,卫生保健资源和治疗的发展进程。

从澳大利亚政府收集了为期15年(2002-2016年)的1849名DBS植入术后PD患者的个体水平数据。为了确定帕金森病患者,选择了服用左旋多巴至少12天的患者 。一些患者因震颤而植入丘脑区。随访时间从DBS植入之日起计算至2016年12月31日研究终点或死亡日期。

image

研究流程图

结果显示患者平均植入年龄62.6岁 。平均随访5.0年 。51.4%的患者需要重复硬件手术。11.3%的患者重复颅内电极手术(包括1.1%完全切除的患者)。47.6%的患者重复IPG/延长电缆手术,包括电池耗尽。首次植入DBS后30天死亡率为0.3%,任何重复手术后30天死亡率为0.6%。住院率为25.3%,死亡率为17.4%。住院治疗和死亡的中位数间隔为10.2 年和11.4 年。 65岁以后植入DBS的患者住院治疗和死亡率较高。2.8%因手术发生感染。DBS植入术后中位生存率为11.4% 

研究结果支持了减少治疗风险技术的发展,如外科导航、硬件小型化和提高电池效率。

Xu, S.S., Malpas, C.B., Bulluss, K.J., McDermott, H.J., Kalincik, T. and Thevathasan, W. (2021), Lesser-Known Aspects of Deep Brain Stimulation for Parkinson's Disease: Programming Sessions, Hardware Surgeries, Residential Care Admissions, and Deaths. Neuromodulation: Technology at the Neural Interface. https://doi.org/10.1111/ner.13466

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    2021-06-19 amyloid
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    2021-06-19 jiyangfei
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    2021-06-18 ms5000000518166734

    已读,真是受益匪浅呀!

    0

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    2021-06-17 医鸣惊人

    认真学习了

    0

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    2021-06-17 ms2000000374477389

    这是高手啊

    0

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