三叉神经痛显微血管减压术中三叉-心脏反射的处理

发布时间：2018-05-10 16:52

本文选题：原发性三叉神经痛 + 显微血管减压　；参考：《中国脑血管病杂志》2017年09期

【摘要】：目的探讨经显微血管减压术治疗原发性三叉神经痛中出现三叉-心脏反射(TCR)的处理措施。方法回顾性分析2016年1月至12月首都医科大学宣武医院神经外科连续收治的79例原发性三叉神经痛、首次开颅行显微血管减压术患者的临床资料。根据术中麻醉监测,分为无TCR组63例和TCR组16例,比较两组基线情况、术前合并症及手术累及三叉神经分支的差异。分析术中发生TCR患者的处理措施及近期预后。结果 (1)TCR组高血压病史比例31.2%(5例)高于无TCR组的7.9%(5例),差异有统计学意义(χ2=6.273,P0.05)。(2)行显微血管减压术过程中,TCR组16例患者共出现TCR 19次。操作前基线心率(74±10)次/min,TCR发生时心率降至(51±6)次/min;基线平均动脉压为(102±13)mm Hg,TCR发生时平均动脉压为(74±8)mm Hg,差异均有统计学意义(P0.05)。(3)TCR出现后停止操作,患者心率和血压自行恢复4例次,应用药物15例次,其中应用阿托品12例次,剂量为0.2~0.5 mg;应用麻黄素3例次,剂量5~10 mg。患者心率及血压在20 s内或给药后20 s内恢复至基线水平;患者术后至出院时,无TCR相关心血管并发症及神经功能缺损。结论在原发性三叉神经痛显微血管减压术中,若发生TCR,需尽早选择性使用抗胆碱能类药物或血管活性药物。TCR发生的危险因素尚有待进一步验证。
[Abstract]:Objective to explore the treatment of TCRs in primary trigeminal neuralgia treated by microvascular decompression. Methods the clinical data of 79 patients with primary trigeminal neuralgia treated by neurosurgery in Xuanwu Hospital of Capital Medical University from January to December 2016 were retrospectively analyzed. According to intraoperative anesthesia monitoring, 63 cases were divided into no TCR group (63 cases) and TCR group (16 cases). The baseline conditions, preoperative complications and operation involving trigeminal nerve branches were compared between the two groups. To analyze the treatment and short-term prognosis of patients with TCR during operation. Results the proportion of hypertension history in TCR group (n = 5) was higher than that in group without TCR (P < 0.01). The difference was statistically significant (蠂 ~ (2 +) 6.273). During microvascular decompression, TCR occurred 19 times in 16 patients in TCR group. Before operation, the heart rate decreased to 51 卤6 times / min after the onset of the baseline heart rate of 74 卤10 times / r / min, and the mean arterial pressure of 10 2 卤13)mm / TCR was 74 卤8)mm / min. The difference was statistically significant (P < 0.05). The heart rate and blood pressure of the patients recovered 4 times. The dosage of atropine and ephedrine were 0.2n0.5mg and 510mg respectively, and the dosage of ephedrine was 5 mg / g, 15 times, 12 times respectively, and 3 cases were given ephedrine (5 mg / g). The heart rate and blood pressure recovered to baseline level within 20 seconds or 20 seconds after administration, and there were no TCR related cardiovascular complications and neurological impairment from postoperative to discharge. Conclusion during microvascular decompression of primary trigeminal neuralgia, the risk factors of selective use of anticholinergic drugs or vasoactive drugs.
【作者单位】：首都医科大学宣武医院神经外科;首都医科大学宣武医院麻醉科;
【基金】：北京市卫生系统215高层次卫生技术人才学术骨干项目(2014-3-061)
【分类号】：R651.3

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