帕金森病外科治疗__培训课件.pptVIP

DBS手术流程 1、病人处于舒适的体位 2、手术在局麻下进行 3、监测病人生命体征 4、调整好C-臂机位置 DBS术后患者伤口恢复情况 DBS 患者管理 调整DBS治疗参数 非侵袭的调节过程，最大化治疗的效果，最小化治疗的副作用; 可以通过调整刺激的触点，从而确定不同的刺激的部位; 病人可以在医生设定的范围内进行调整参数; 一旦参数相对固定以后，需要调节的次数很少. DBS术后病人的程控随访 最佳的症状控制 最低的副作用 最长的电池使用寿命 程控目标: 7436病人程控仪 * *Humanitarian Device: Authorized by Federal Law for the use as an aid in the management of chronic, intractable (drug refractory) primary dystonia, including generalized and segmental dystonia, hemidystonia, and cervical dystonia, for individuals 7 years of age and older. * In the prospective, randomised, double-bind, crossover multi-center study conducted by the Deep-Brain Stimulation for Parkinsons Disease Study Group, 96 patients with advanced, drug-refractory PD underwent bilateral stimulation of the STN with Medtronic DBS? Therapy. Patients completed a home diary documenting their motor status during the 2 days before each visit. Three motor states were identified: poor mobility (‘Off’), good mobility without dyskinesia (‘On’ without dyskinesia), and good mobility with dyskinesia (‘On’ with dyskinesia). Assessments of the percentage of time with good mobility and without dyskinesia (‘On’ without dyskinesia) during the waking time increased from 27% at baseline to 74% at six months, a 3-fold gain. This was paralleled by a decrease in the percentage of time with poor mobility (‘Off’ state), from 49% to 19%. Deep-Brain Stimulation for Parkinsons Disease Study Group. “Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinsons disease.” N Engl J Med 2001; 345: 956–63. PD = Parkinson’s disease; STN = subthalamic nucleus; DBS = deep-brain stimulation Title | Description * Title | Description * 帕金森病外科治疗 西安交通大学医学院第一附属医院 神经外科 陈伟博士 帕金森病外科治疗 立体定向毁损手术； 脑深部电刺激治疗； 干细胞疗法； 立体定向毁损术 在左旋多巴发现以前便应用于帕金森病的治疗； 应用立体定向技术将毁损源准确引导至靶点，按照预定的要求对靶 点进行毁损，从而制造处毁损灶或对病灶产生治疗性损害的技术； 试图中断脑内的异常活动； 丘脑毁损术； 苍白球毁损术； 丘脑底核毁损术； 目前射频毁损技术临床应用较多； 立体定向毁损术 单侧毁损手术的近期疗效很好，可以缓解帕金森病患者手术靶点对侧肢体的肌僵