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題 名 | Acute Effects of Bilateral Subthalamic Stimulation Implantation on Heart Rate Variability of Patients with Parkinson's Disease=巴金森病患植入兩側視丘下核刺激器對心率變異性的早期影響 |
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作 者 | 哈鐵木爾; 陳新源; 楊靜修; 辛裕隆; 林欣榮; 郭博昭; | 書刊名 | 慈濟醫學 |
卷 期 | 17:1 民94.02 |
頁 次 | 頁21-26+57 |
分類號 | 415.83 |
關鍵詞 | 自主神經; 深腦刺激術; 心率變異; 巴金森症; 視丘下核; Autonomic function; Deep brain stimulation; Heart rate variability; Parkinson's disease; Subthalamus; |
語 文 | 英文(English) |
中文摘要 | 目的:巴金森症可以造成自主神經對心血管系統或其他身體系統調控的障礙,此種問題提高了巴金森病患的致病及死亡率。兩側視丘下核刺激術藉由高頻刺激可以使視丘下核神經細胞活性降低,因而有效達成控制巴金森症的目的。然而我們對此種手術本身是否會影響下視丘等腦自主神經中樞並不瞭解。因此設計了此研究。材料與方法:我們對4名重度的巴金森病患做各四次第一肢導程,每次300秒的心率紀率,並分析其心率變異性。第一次的紀錄時間點在全身麻醉下,視丘下核刺激器植入前(T1)。第二次的紀錄時間點在刺激器植入後(T2)。第三次的紀錄時間點是在全身麻醉下給予頻率130Hz,每人60μs,電量1V的刺激10分鐘。而在後5分鐘作紀錄(T3)。第四次的紀錄時間點是在全身麻醉下當予頻率130Hz,每次μs,電量3V的刺激10鐘。而在後5分鐘作紀錄(T4)。心率在經快速傅立葉類比-數位轉換(FFT)後,作頻譜分析並區分為低頻(low frequency-LF)(0.04-0.15 Hz)及高頻(high frequency-HF)(0.15-0.4 Hz)功率頻譜。我們使用Paired t-test統計法來分析不同紀錄時間點兩兩之間的差異。結果:我們發現在代表交感神經調控指標的LF%及LH/HF比值於T1及T2之間具有統計意義的降低。而且這種差異性在T3,T4時並未擴大。這表示交感神經調控的改變來自於手術的傷害。在代表自主神經總合迷走神經調控指標的功率部分,則在四個記錄時間點之間沒有差異性。結論:視丘下核刺激器植入後,藉由手術對視丘下核的破壞效果,可以在早期降低中樞對心血管系統交感神經的張力。 |
英文摘要 | Objective: Impaired autonomic cardiovascular regulation and other autonomic nervous system dysfunctions have been reported in patients with Parkinson’s disease (PD). These issues increase the long-term risk of morbidity and mortality in patients with PD. Deep brain stimulation of bilateral subthalamic unclei (STN-DBS) is an effective treatment option in advanced PD with ‘tetanic stimuatlion’ silencing the subthalamic neurons. We hypothesized that the function of the hypothalamus and other autonomic centers are not affected by the surgery itself. Materials and Methods: In 2003, four Parkinson’s patients were enrolled in this study. Under general anesthesia, we recorded the lead I ECG for a duration of 300 seconds for analysis of the heart rate variability (HRV) before (T1) and after (T2) STN-DBS were implanted. After the surgical procedures were completed, the STN-DBS was turned on to a frequency of 130 Hz, pulse width of 60μs, and voltage of 1 V for 10 minutes. The third ECG records for analysis of the HRV were performed during the last 5 minutes of STN-DBS (T3). Then, the voltage was increased to 3 V for another 10 minutes. The fourth ECG records for analysis of the HRV were performed in the latter 5 minutes of 3 V-simulation (T4). Frequency domain analysis was performed using the nonparametric method of fast Fourier transformation (FFT). The power spectrum was subsequently quantified into various frequency measurements as defined previously. A paired t-test was used for comparison within the groups at the four recording times. Results: The reductions from T1 to T2 were significantly demonstrated in the LF% and ration LF/HF. However, the differences did not increase at the times of T3 and T4. the changes of the sympathetic indicators were due to the lesion effects of the surgery. There were no significant change in the total autonomic or vagal indicators. Conclusions: STN-DBS surgery reduced the extent of sympathetic modulation upon the cardiovascular system in patients with Parkinson’s disease. The results were achieved immediately by the lesion effects of the surgery itself. |
本系統中英文摘要資訊取自各篇刊載內容。