Abstract: Objective To compare the efficacy and safety of subthalamic nucleus (STN) deep brain stimulation (DBS) under local and general anesthesia in the treatment of Parkinson's disease. Methods In this study,from January 2024 to July 2024,86 patients with Parkinson's disease who underwent bilateral STN DBS surgery in the Department of Neurosurgery of our hospital were randomly enrolled,including 42 patients in the local anesthesia group and 44 patients in the general anesthesia group.Clinical efficacy,drug reduction,operation time,hospital stay,electrode position error,and surgical complications were comprehensively compared between the two groups before and 3 months after operation. Results At the 2-week follow-up,HAMA and HAMD scores in the general anesthesia group were significantly lower than those in the local anesthesia group (P=0.001;P=0.015),MoCA score in general anesthesia group was significantly higher than that in local anesthesia group (P=0.023).At the follow-up 3 months after surgery,there were no significant differences in HAMA score,HAMD score,MoCA score,UPDRS-Ⅲscore difference,PDQ-39 score difference and levodopa equivalent daily dose difference between the general anesthesia group and the local anesthesia group.However,the operation time of the general anesthesia group was shorter than that of the local anesthesia group (P=0.001).The length of hospital stay was shorter (P=0.016),and the accuracy of electrode implantation in general anesthesia group was better than that in local anesthesia group (P=0.035).No serious postoperative complications such as cerebral hemorrhage,intracranial infection and cerebral infarction occurred in all patients. Conclusion The clinical efficacy,drug reduction and surgical complications of STN DBS under general and local anesthesia are similar,but the operation time and hospital stay are shorter under general anesthesia,which is especially suitable for patients with Parkinson's disease with severe anxiety and symptoms.

Key words: Parkinson's disease, Deep brain stimulation, Subthalamic nucleus, General anesthesia, Local anesthesia

摘要： 目的 对比分析局麻和全麻下丘脑底核(subthalamic nucleus,STN)脑深部电刺激术(deep brain stimulation,DBS)治疗帕金森病的疗效及安全性。方法 本研究于2024年1月至2024年7月,随机纳入我院神经外科行双侧 STN DBS 手术的帕金森病患者86例,局麻组42例,全麻组44例。全面对比分析两组患者术前与术后3个月时临床疗效、药物减少情况、手术时间、住院时间、电极位置误差,以及手术并发症。结果 术后2周随访时,全麻组HAMA评分和HAMD评分明显低于局麻组(P=0.001;P=0.015),全麻组MoCA 评分明显高于局麻组(P=0.023)。术后3个月随访时,全麻组和局麻组HAMA 评分、HAMD评分、MoCA评分、UPDRS-Ⅲ评分差值、PDQ-39评分差值、左旋多巴等效日剂量差值均无明显差异,但是,全麻组比局麻组手术时间更短(P=0.001),住院时间更短(P=0.016),全麻组电极植入准确度优于局麻组(P=0.035)。所有患者均未发生脑出血、颅内感染、脑梗塞等严重术后并发症。结论 全麻和局麻下STN DBS临床疗效、药物减少情况和手术并发症相似,但是,全麻下手术时间更短,住院时间更短,尤其适合焦虑和症状严重的帕金森病患者。

关键词: 帕金森病, 脑深部电刺激, 丘脑底核, 全身麻醉, 局部麻醉