Department of Neurosurgery, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
Department of Neurosurgery, HCPA, UFRGS, Porto Alegre, Brazil.
World Neurosurg. 2019 May;125:e966-e971. doi: 10.1016/j.wneu.2019.01.216. Epub 2019 Feb 11.
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an established treatment for patients with Parkinson disease. One adverse event is the development of postoperative confusion. The aim of this study was to report the incidence and associated factors of postoperative confusion after STN DBS surgery.
This was a retrospective cohort study by chart review of patients with Parkinson disease who underwent STN DBS in a Brazilian public academic hospital from January 2013 to October 2017. The primary outcome was the incidence of postoperative confusion. The association of the outcome and imaging and clinical variables was evaluated.
Among 49 patients who underwent STN DBS for Parkinson disease, the incidence of postoperative confusion was 26.5% (95% confidence interval 15%-41.1%). Univariate analysis identified the following variables associated with development of confusion: age (63.2 ± 7.8 years vs. 55.4 ± 9.1 years, P = 0.009), disease duration (16.5 ± 5.1 years vs. 13.2 ± 4.2 years, P = 0.027), Charlson comorbidity index (2 [interquartile range 1-3] vs. 1 [0-1 interquartile range], P = 0.002), width of the third ventricle (5.4 ± 2.1 mm vs. 4 ± 1.6 mm, P = 0.018), and cella media index (5 ± 1 vs. 5.6 ± 0.8, P = 0.018). After adjustment, Charlson comorbidity index remained significant (adjusted relative risk 1.64, 95% confidence interval 1.17-2.3, P = 0.004).
The incidence of postoperative confusion in this cohort was 26.5%. After analysis of confounding factors, the Charlson comorbidity index was significantly associated with postoperative confusion.
深部脑刺激（DBS）对丘脑底核（STN）的刺激是治疗帕金森病患者的一种既定方法。一个不良事件是术后出现意识混乱。本研究的目的是报告 STN-DBS 手术后出现术后意识混乱的发生率和相关因素。
这是一项回顾性队列研究，通过对 2013 年 1 月至 2017 年 10 月在巴西一所公立学术医院接受 STN-DBS 的帕金森病患者的病历进行回顾性分析。主要结果是术后意识混乱的发生率。评估了结果与影像学和临床变量的相关性。
在 49 例接受 STN-DBS 治疗帕金森病的患者中，术后意识混乱的发生率为 26.5%（95%置信区间 15%-41.1%）。单因素分析确定了以下与意识混乱发生相关的变量：年龄（63.2 ± 7.8 岁 vs. 55.4 ± 9.1 岁，P=0.009）、疾病持续时间（16.5 ± 5.1 年 vs. 13.2 ± 4.2 年，P=0.027）、Charlson 合并症指数（2 [四分位间距 1-3] vs. 1 [0-1 四分位间距]，P=0.002）、第三脑室宽度（5.4 ± 2.1 毫米 vs. 4 ± 1.6 毫米，P=0.018）和中隔指数（5 ± 1 与 5.6 ± 0.8，P=0.018）。调整混杂因素后，Charlson 合并症指数仍有统计学意义（调整后的相对风险 1.64，95%置信区间 1.17-2.3，P=0.004）。
在本队列中，术后意识混乱的发生率为 26.5%。在分析混杂因素后，Charlson 合并症指数与术后意识混乱显著相关。
