帕金森病患者脑深部电刺激术后神经精神功能障碍发生率及其影响因素分析:一项前瞻性队列研究

Incidence and Risk Factors of Postoperative Neuropsychiatric Dysfunctions after Deep Brain Stimulation Surgery in Patients with Parkinson’s Disease: A Prospective Cohort Study

  • 摘要: 目的 探究脑深部电刺激(deep brain stimulation,DBS)治疗的帕金森病( Parkinson's disease,PD)患者术后神经精神功能障碍( postoperativeneuropsychic dysfunction,PND)发生情况,并分析其影响因素。方法 前瞻性招募2020年1月—2022年12月首都医科大学附属北京天坛医院功能神经外科门诊的PD患者为研究对象。所有患者均拟行以双侧双侧丘脑底核(subthalamicnucleus,STN)为靶点的DBS手术。收集患者围术期临床资料,并结合蒙特利尔认知评估量表、简易精神状态检查量表、汉密尔顿抑郁与焦虑量表、三分钟意识模糊评估量表判定患者术后3 d内是否出现PND(结局指标)。采用多因素Logistic回归法分析PND的影响因素。结果 共招募216例PD患者。DBS术后3 d内出现PND 77例(33.8%) ,包括出现抑郁或其程度加重24例(31.2%),出现焦虑或其程度加重16例(20.8%),认知功能评级下降13例(16.9%),出现谵妄表现24例(31.2%)。单因素分析结果显示,硬脑膜开放方式、硬脑膜开放时间、术中统一帕金森氏病综合评分量表第三部分( the united Parkinson’sdisease rating scale-III,UPDRS-III)评分改善率、术后颅内气体体积在PND患者与非PND患者之间具有统计学差异(P均<0.05)。多因素Logistic回归分析结果显示,女性(OR=2.468,95% CI: 1.077~5.657,P=0.033)、术后颅内气体体积(OR=1.214,95% CI: 1.117~1.320,P<0.001)是PD患者DBS术后PND的独立危险因素,而术中较高的UPDRS-III评分改善率为其保护性因素(OR=0.895,95% CI: 0.865~0.925,P<0.001)。结论 DBS术后PD患者具有较高的PND发生率,性别、术后颅内积气量和PD运动症状改善程度可影响PND发生风险,提示针对性别进行个体化管理、提升手术技巧并加强患者神经精神状态监测在优化DBS手术疗效中的重要性。

     

    Abstract: Objective To investigate the incidence of postoperative neuropsychic dysfunction (PND) in Parkinson's disease (PD) patients undergoing deep brain stimulation (DBS) and to analyze its influencing factors. Methods A prospective study was conducted, recruiting PD patients from the Functional Neurosurgery Outpatient Clinic of Beijing Tiantan Hospital, Capital Medical University, between January 2020 and December 2022. All patients were scheduled to undergo bilateral subthalamic nucleus (STN)-DBS surgery. Perioperative clinical data were collected, and PND (outcome measure) within 3 days postoperatively was assessed using the Montreal cognitive assessment (MoCA), mini-mental state examination (MMSE), Hamilton depression and anxiety scales, and 3-minute diagnostic interview for confusion assessment method (3D-CAM). Multivariate Logistic regression was used to analyze the influencing factors of PND. Results A total of 216 PD patients were enrolled. Within 3 days after DBS surgery, 77 patients (33.8%) developed PND, including 24 cases (31.2%) of depression or worsening depression, 16 cases (20.8%) of anxiety or worsening anxiety, 13 cases (16.9%) of cognitive decline, and 24 cases (31.2%) of delirium. Univariate analysis revealed that dural opening method, dural opening time, intraoperative improvement rate of the unified Parkinson's disease rating scale part III (UPDRS-III) score, and postoperative intracranial air volume were significantly different between PND and non-PND patients (all P < 0.05). Multivariate Logistic regression analysis showed that female sex (OR = 2.468, 95% CI: 1.077– 5.657, P = 0.033) and postoperative intracranial air volume (OR = 1.214, 95% CI: 1.117–1.320, P < 0.001) were independent risk factors for PND, while a higher intraoperative UPDRS-III improvement rate was a protective factor (OR = 0.895, 95% CI: 0.865–0.925, P < 0.001). Conclusions PD patients have a high incidence of PND after DBS surgery. Sex, postoperative intracranial air volume, and the degree of improvement in PD motor symptoms can influence the risk of PND. These findings highlight the importance of individualized management based on sex, improving surgical techniques, and enhancing monitoring of neuropsychiatric status to optimize the efficacy of DBS surgery.

     

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