【摘要】 目的探讨丘脑底核-脑深部刺激术(STN-DBS)治疗帕金森病(PD)相关疼痛的疗效,以及疼痛与焦虑抑郁的相关性。方法对淮安市第二人民医院及南京医科大学附属脑科医院2018年1月—2019年12月,行双侧STN-DBS治疗的存在疼痛症状的43例中晚期PD患者的临床资料进行回顾分析。所有患者术后1个月开机并随访6个月,采用视觉模拟评分(VAS)法评价患者疼痛程度,汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)评价焦虑抑郁症状。总结STN-DBS治疗PD相关疼痛的疗效,分析疼痛与焦虑抑郁的相关性。结果本组患者中,28例患者(65.1%)存在疼痛微毁损效应。开机后6个月时,41例患者(95.3%)的疼痛症状减轻,VAS评分为(1.19±1.47)分,显著低于术前的(3.51±1.84)分(P <0.05),平均改善为66.1%。患者术后HAMA、HAMD评分分别为(13.16±4.52)分和(15.35±4.19)分,显著低于术前的(17.21±5.47)分和(21.60±4.82)分(均P <0.05)。VAS评分与HAMA、HAMD评分均呈正相关(r=0.664,r=0.505,均P <0.001)。结论中晚期PD患者的疼痛症状与焦虑抑郁有显著关系; STN-DBS治疗可有效改善其疼痛症状,并且多数患者存在疼痛微毁损效应。更多还原

【Abstract】 Objective To summarize and analyze the clinical efficacy of subthalamic nucleus deep brain stimulation(STN-DBS) in the treatment of Parkinson’s disease(PD) related pain and to analyze the correlation between pain and anxiety/depression. Methods The clinical data of 43 patients with advanced PD who underwent STN-DBS treatment in the Second People’s Hospital of Huaian City and Nanjing Brain Hospital from January 2018 to December 2019 were analyzed retrospectively. All patients started up 1 month after operation and followed up for 6 months. The visual analogue scale(VAS) was used to evaluate the degree of pain. Hamilton anxiety scale(HAMA) and Hamilton depression scale(HAMD) were used to evaluate anxiety and depression symptoms. The efficacy of STN-DBS in the treatment of PD related pain,and the correlation between pain and anxiety/depression were summarized. Results The electrode position was accurate in 43 patients with PD,there were 28(65. 12%) had microlesion effect(MLE) of pain,41(95. 35%) had pain relief at 6 months postoperatively,VAS score was(1. 19 ± 1. 47),significantly lower than baseline of(3. 51 ± 1. 84)(P < 0. 05),with an average improvement of 66. 10%. The postoperative HAMA and HAMD scores were(13. 16 ± 4. 52) and(15. 35 ± 4. 19),which were significantly lower than those before operation(17. 21 ± 5. 47) and(21. 60 ± 4. 82)(P < 0. 05),the correlation coefficients of HAMA,HAMD and VAS scores were 0. 664(P < 0. 001),0. 505(P < 0. 001). Conclusion Pain in patients with advanced PD is significantly related to anxiety and depression,STN-DBS can effectively alleviate the symptoms of PD related pain,and most of them have MLE of pain.更多还原