颅底手术中的三叉-心反射

发布时间：2018-01-16 13:01

本文关键词：颅底手术中的三叉-心反射　出处：《北京大学学报(医学版)》2017年01期 　论文类型：期刊论文

【摘要】：目的:探讨颅底手术中出现三叉-心反射(trigemino-cardiac reflex,TCR)的形成机制、临床特征及相关预后。方法:回顾性分析2009年1月至2015年10月北京大学第一医院神经外科291例颅底手术患者,通过复习相关的手术资料及麻醉记录,找出术中出现TCR的病例(在刺激或操作三叉神经相关区域时,出现与麻醉因素无关的平均动脉压突然下降和心率突然减慢并超过基线值的20%),分析其手术方式、临床特征、影响因素及相应预后。结果:291例颅底手术患者中,9例患者术中共出现TCR 19次,包括神经鞘瘤4例(听神经瘤3例,三叉神经鞘瘤1例)、脑膜瘤1例、表皮样囊肿1例、海绵窦海绵状血管瘤1例、垂体瘤1例、三叉神经痛1例。TCR诱发方式均与三叉神经主干或其分支受操作、牵拉有关,操作前基线心率为62~119/min,平均(79.4±14.6)/min,TCR发生时,心率为22~60/min,平均(44.2±9.6)/min,心率下降比例为29.0%~66.4%,平均下降比例为44.3%。基线平均动脉压为75~103 mm Hg,平均(87.5±7.8)mm Hg,TCR发生时,平均动脉压为45~67 mm Hg,平均为(54.9±6.3)mm Hg,血压下降比例为23.4%~47.2%,平均下降比例为37.3%。TCR出现后,停止刺激或操作心率血压自行恢复者8例次,应用阿托品8例次,剂量0.5~1.0 mg,平均0.69 mg,应用盐酸麻黄碱1例次,应用肾上腺素1例次,应用多巴胺1例次,患者血压及心率均很快恢复至基线水平,重复刺激可再次诱发。术后24 h无TCR相关心血管并发症及神经功能障碍。结论:TCR是在颅底手术中由于对三叉神经或其分支操作刺激时出现的一种以心率变慢、血压降低为表现的神经反射,虽然其预后良好,但仍需正确判断、密切观察,必要时需给予处理。
[Abstract]:Objective: To investigate the skull base surgery in the trigeminal - heart reflex (trigemino-cardiac reflex, TCR) the formation mechanism, clinical features and prognosis. Methods: a retrospective analysis from January 2009 to October 2015 in the Department of Neurosurgery of No.1 Hospital of Peking University in 291 cases of skull base surgery patients, surgery and anesthesia through the review of related data records, find out the TCR operation in case (mean arterial independent the sudden drop in pressure and anesthesia factors and heart rate suddenly slowed down and exceeded the baseline value of 20% appears in the operation of the trigeminal nerve stimulation or related area,), analysis of the surgical methods, clinical features, influencing factors and corresponding prognosis. Results: 291 cases of skull base surgery patients, 9 cases of patients with the TCR 19 times, including there were 4 cases (3 cases of acoustic neuroma, 1 cases of trigeminal schwannoma), 1 cases of meningioma, 1 cases of epidermoid cyst, 1 cases of cavernous hemangioma, 1 cases of pituitary adenoma, trigeminal nerve The pain of 1 cases were induced by.TCR and trigeminal nerve trunk and its branches by operation, traction, operation of the baseline heart rate was 62~119/min, the average (79.4 + 14.6) /min, TCR, heart rate was 22~60/min, the average (44.2 + 9.6) /min, the heart rate decreased the ratio of 29.0%~66.4%, the average decline in the ratio of 44.3%. the baseline mean arterial pressure was 75~103 mm Hg, the average (87.5 + 7.8) mm Hg, TCR, 45~67 mm Hg, mean arterial pressure, average (54.9 + 6.3) mm Hg, the blood pressure decreased the ratio of 23.4%~47.2%, the average ratio of 37.3%.TCR decreased after stopping stimulation or operation of heart rate and blood pressure in self recovery in 8 cases, 8 cases of application of atropine, dose 0.5~1.0 mg, average 0.69 mg, the application of ephedrine hydrochloride in 1 cases, 1 cases of epinephrine, dopamine in 1 cases, blood pressure and heart rate of the patients were quickly returned to baseline levels, repetitive stimulation could be induced. After 24 h TCR Cardiovascular complications and neurological dysfunction. Conclusion: TCR in skull base surgery due to the emergence of a trigeminal nerve or its branches to stimulate the operation slow heart rate, lower blood pressure for the performance of the neural reflex, although the prognosis is good, but still need to correct judgment, close observation should be given when necessary.

【作者单位】：北京大学第一医院神经外科;
【基金】：国家自然科学基金(81541119) 高等学校博士学科点专项科研基金(20110001120050)资助~~
【分类号】：R651.1
【正文快照】： 三叉-心反射(trigemino-cardiac reflex,TCR)是一种脑干反射,常见于眼科手术,但自从Schaller等[1]于1999年第1次报道神经外科手术中的TCR以来,其越来越引起神经外科医师及麻醉科医师的重视。典型的TCR的临床表现为:突发性心动过缓,血压降低,可伴有呼吸暂停及胃肠蠕动过强等,常

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