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脑深部电刺激会增加诱发性精神病的发病率吗?对2004年至2017年100例患者的术后随访。

Will deep brain stimulation increase the incidence of induced psychosis? Post-operation follow-ups for 1 hundred patients from 2004-2017.

作者信息

Chen Paul-Jer

机构信息

Department of Neurosurgery, China Medical University Hospital, China Medical University, Taichung 404, Taiwan.

出版信息

Biomedicine (Taipei). 2018 Dec;8(4):21. doi: 10.1051/bmdcn/2018080421. Epub 2018 Nov 26.

Abstract

Generally regarding as a safe treatment for Parkinson's disease (PD) for the past 20 years, deep brain stimulation (DBS) is also an example of precision medicine where surgeons need to titrate individual patient's stimulating electrodes one by one down to the scale of micrometer for the maximum therapeutic effect. In order to prevent operation induced psychiatric complications and minimize any other potential side effects, we have followed 103 patients received this treatment provided by a single surgeon in the same medical institution from 2004 to 2017. We identified each patient complaint from nursing care records and complication data from medical charts during the perioperative hospitalization period to see if any of them correlate statistical significantly with the DBS lead placement procedure. Top five frequent complaints including fever, constipation, nausea, headache, wound pain. The majority of post-operative complaints turned out to be the same as general post-operative / post-anesthesia side effects rather than the DBS operation itself. However, a few rare but critical complications such as post-operative intracranial hemorrhage (ICH), postoperative epidural hematoma (EDH) were identified as well. These patients' subsequent treatments and prognosis were documented for revising the operating procedure in the future. Our retrospective study reconfirmed that DBS is indeed a relatively safe procedure and improve the life quality of PD patients in general. Hopefully, the through preoperative preparation and careful surgical approach will safeguard the patient's prognosis.

摘要

在过去20年里,深部脑刺激(DBS)通常被视为治疗帕金森病(PD)的一种安全疗法,它也是精准医疗的一个范例,外科医生需要将每个患者的刺激电极逐一调整到微米级别,以达到最大治疗效果。为了预防手术引起的精神并发症并将其他潜在副作用降至最低,我们跟踪了2004年至2017年在同一医疗机构由同一位外科医生进行这种治疗的103例患者。我们从围手术期住院期间的护理记录中识别出每位患者的投诉,并从病历中获取并发症数据,以查看其中是否有任何与DBS电极植入程序存在显著统计学关联。最常见的五大投诉包括发热、便秘、恶心、头痛、伤口疼痛。大多数术后投诉结果与一般术后/麻醉后副作用相同,而非DBS手术本身所致。然而,也发现了一些罕见但严重的并发症,如术后颅内出血(ICH)、术后硬膜外血肿(EDH)。记录了这些患者随后的治疗情况和预后,以便将来修订手术程序。我们的回顾性研究再次证实,DBS确实是一种相对安全的手术,总体上可提高PD患者的生活质量。希望通过术前充分准备和谨慎的手术方法能保障患者的预后。

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本文引用的文献

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Anti-Coagulation and Deep Brain Stimulation: Never the Twain Shall Meet.抗凝与深部脑刺激:二者永不相交。
Stereotact Funct Neurosurg. 2015;93(6):373-7. doi: 10.1159/000441232. Epub 2015 Nov 18.

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