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脑起搏器疗法术后管理第四军医大学唐都医院神经外科王学廉课件

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起搏器 疗法 术后 管理 第四 军医大学 医院 神经外科 王学廉 课件
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第四军医大学唐都医院 功能神经外科王学廉 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 脑深部电刺激 DBS 在帕金森病治疗中的应用 q 成功的脑深部电刺激治疗的要素 选择合适的患者 患者术前教育 精确的手术 最佳患者术后管理 最佳合作团队 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 最佳患者术后管理 q 最佳症状控制 q 最小副作用 q 抗帕金森药物调整 q 延长脉冲发生器电池寿命 q 最佳生活心理状态的建立 q 运功功能的良好保持 术后管理目标 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术后程控的一些基本概念 N Vision 8840 程控仪 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术后程控的一些基本概念 Managing Parkinson s Disease Patients with Activa DBS Therapy 程控参数调整 频率 Hertz 每秒刺激的数量 脉宽 usec 每次刺激持续的时间 电压 Volts 刺激的强度 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术后程控的一些基本概念 Managing Parkinson s Disease Patients with Activa DBS Therapy 程控参数调整 0 1 2 3 负极发挥治疗效应 Lead Electrodes 双极刺激单极刺激 0123 0 1 2 3off off off positiveoff off off Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术后程控的一些基本概念 Managing Parkinson s Disease Patients with Activa DBS Therapy 程控参数调整 单极刺激双极刺激 神经束 希望得到刺激 的神经纤维 希望得到刺激 的神经纤维 会发生副反应的 神经纤维 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术后程控的一些基本概念 Managing Parkinson s Disease Patients with Activa DBS Therapy 影响刺激器寿命的因素 估算依据 q 电压 q 脉宽 q 频率 q 刺激触点 q 刺激时间及电阻 q 刺激模式 尽可能低的设置电压 脉宽和频率 指导病人在不需要时关闭IPG 尽可能采用双极刺激模式 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术后程控的一些基本概念 Managing Parkinson s Disease Patients with Activa DBS Therapy 电极的位置直接影响程控的效果 Thalamus Substantia nigra lateral medial ventral Paresthesias Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 初次程控需要注意的问题 Managing Parkinson s Disease Patients with Activa DBS Therapy 对目标症状产生疗效的潜伏期 目标症状 僵直 震颤 运动迟缓 运动困难 关期 肌张力障碍 异动症 开期异动症或 刺激所诱发的异常运动 改善潜在时间 数秒 数秒 数月 数秒 数天 数秒 数分钟 数天 数月 根据药物调整及刺激增加情况 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 患者程控记录表 Managing Parkinson s Disease Patients with Activa DBS Therapy No 有效 副作用单极 双极Case01234VPWRate 1最低有效单 2最高副作用单 3最低有效单 4最高副作用单 5最低有效单 6最高副作用单 7最低有效单 8最高副作用单 9最低有效单 10最高副作用单 11最低有效1双 12最低有效2双 13最低有效3双 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 患者处理流程图 STN Managing Parkinson s Disease Patients with Activa DBS Therapy Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术后安全使用DBS设备 Managing Parkinson s Disease Patients with Activa DBS Therapy q 诊断性超声 如果直接用于植入部位 会损坏 IPG q 高输出超声 碎石术 会损坏 IPG q 放射治疗 钴60直接用于 IPG 上 会损坏 IPG q 防盗装置 可能引起 IPG 开或关 即使 IPG 处于 关的状态 一 些病人也可能感到短暂的刺激增强 病人应小心地通过防 盗装置 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术后安全使用DBS设备 Managing Parkinson s Disease Patients with Activa DBS Therapy q 心脏起搏器 可能会影响按需型心脏起搏器 q MRI 可能引起 IPG 或电极移位 可能在电极中诱发电压 产生 不舒适的刺激 I检查时刺激电压调零 并关闭IPG MRI不超过1 5T 头线圈 q 透热疗法 如果直接用于 IPG 上 会损坏 IPG q 电凝术 会抑制 IPG 输出或重新调控 IPG 不要在 IPG 或电极 附近使用 应使用双极电凝器 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术后安全使用DBS设备 Managing Parkinson s Disease Patients with Activa DBS Therapy q 强磁场 如立体声扬声器 会引起 IPG 开或关 q 工作环境中 电焊设备 感应炉 通讯设备如 微波中转站 线性功率放大器 高功率中转站 高压电线 如果距离过近 会产生电磁干扰 影响IPG的运行 q 控制磁铁可能影响计算机磁盘 信用卡及其他会受强磁场影 响的物件 建议远离这些物件15cm以上 q 如果病人去世后 要进行火葬 应将 IPG 移出 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术后患者教育 Managing Parkinson s Disease Patients with Activa DBS Therapy 患者控制器使用 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 常见问题 Managing Parkinson s Disease Patients with Activa DBS Therapy 1 程控周期是多长 排除首次开机失败需要的反复调试外 一般周期在6 12月 视帕金森病的进展速度而定 2 什么情况下需要程控 A 减药后10 15天 症状加重 B 自感症状加重 开期缩短 C 新增不适 且在用药开期可缓解 D 突发症状加重 自行开关无效 E 必须行磁共振检查时 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 程控以外的管理 Managing Parkinson s Disease Patients with Activa DBS Therapy p 稳定的心理 p 平稳的用药 p 合理的预期 p 持续的锻炼 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 唐都程控中心的管理 Managing Parkinson s Disease Patients with Activa DBS Therapy p 全员参与的程控团队 p 专人负责制 p 定时与预约结合 p 具备应急处置能力 p 门诊与上门程控相结合 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 唐都程控中心的管理目标 Managing Parkinson s Disease Patients with Activa DBS Therapy p 精确的手术植入 p 最优的程控调节 p 最长的使用周期 p 全面负责地提高患者疗效 p 最经济及时的解决患者诉求 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 上门程控与换电池规则 Managing Parkinson s Disease Patients with Activa DBS Therapy 1 上门程控与更换电池仅针对本帕金森病友互助会会员服务 2 由具有程控资格的专业医生志愿者利用节假日完成 3 在本行为过程中 志愿者不得收取任何个人费用 4 在本行为过程中产生的差旅费由提出申请的患者及同地区有程控需要 的其他患者共同承担 实报实销 5 考虑程控风险 程控地点限于靠近医疗机构的宾馆 非特殊情况 禁 止在患者家中程控 6 在接到程控申请后 三周内安排程控 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Managing Parkinson s Disease Patients with Activa DBS Therapy Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Managing Parkinson s Disease Patients with Activa DBS Therapy
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本文标题:脑起搏器疗法术后管理第四军医大学唐都医院神经外科王学廉课件
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