RÉSUMÉ
Objective To analyze the influence of general anesthesia (GA) on bilateral subthalamic nucleus deep brain stimulation (STN-DBS) in treating Parkinson's disease (PD) through microelectrode recording (MER),and discuss the differences between different modes of anesthesia.Methods A retrospective analysis was performed on clinical data of 31 PD patients accepted bilateral STN-DBS in our hospital from June 2015 to June 2017.Nine patients accepted surgery under GA (A group):4 patients were treated with intravenous anesthesia (A1 group),and 5 patients were treated with inhalation anesthesia (A2 group);22 patients accepted surgery under local anesthesia LA group.MER indexes,including STN discharge frequency,STN recorded length,and maximum target error,and short-term (6 months) efficacy were recorded.A linear regression analysis was performed to find possible influence factors on discharge frequency and improving rate of UPDRS scores.Results The discharge frequencies of B group,A1 group and A2 group were 51.42 Hz±6.28 Hz,35.79 Hz±7.02 Hz and 43.18 Hz±5.87 Hz,respectively,with significant differences (F=12.181,P=0.000);as compared with that in the B group,the discharge frequencies of A1 group and A2 group were significantly lower (P＜0.05).The STN recorded lengths of B group,A1 group and A2 group were 5.48 mm±0.33 mm,5.06 mm±0.15 mm and 5.22 mam±0.16 mm,respectively,with significant differences (F=4.115,P=0.027);as compared with that in the B group,the recorded lengths of A1 group and A2 group were significantly shorter (P＜0.05).A1 group had the maximum target error,but no significant differences were noted among the 3 groups (P＞ 0.05).Six months after the surgery,the UPDRS-Ⅲ scores and Schwab-England scores of A group and B group were decreased and daily levodopa equivalent (LEDD) was decreased.As compared with B group,A group had significantly better improvement in Hoehn & Yahr grading (P＜0.05).Disease durations were positively correlated with discharge frequency (r=0.539,P=0.002);age and improving rate of UPDRS scores were negatively correlated (r=-0.572,P=-0.001);preoperative LEDD and improving rate of UPDRS scores were positively correlated (r=0.725,P=-0.000).Conclusions Bilateral STN-DBS performed under GA in PD enjoys good efficacy,which shows no obvious difference as compared with that under LA.Inhalation anesthesia had less influence on electrophysiology than intravenous anesthesia.
RÉSUMÉ
The detection of R-wave of ECG is essential to the analysis of the heart rate variability (HRV). In this paper, an R-wave detection method using wavelet transform(WT) is presented in line with the principle of discrete wavelet transform(DWT) and multi-resolution technique (MRT). We made use of the special properties of dbl wavelet in time-domain, decomposed the original ECG signals into 3-level detailed signals on different frequency bands by using DWT with Mallat algorithm, and got appropriate threshold values in different high frequency bands to distinguish R-wave. It is concluded that the algorithm had significant effects on it, which is verified by MIT/BIH (Massachusetts Institute of Technology/Boston's Beth Israel Hospital) ECG Database. The results show that R-wave could be detected accurately and localized precisely by this method, even when the patient was seriously sick or the signal was disturbed by noise. Consequently the method has a quite high locating precision (its error is not more than two sampled points and about 85 percent of the points of R-wave in ECG signal are localized precisely) and the correct detection rate of R-wave is 99.8% by using wavelet transform, so this method is quite feasible.