CT引导下半月神经节脉冲射频治疗青老年三叉神经痛患者的临床疗效比较

发布时间：2018-04-30 15:09

本文选题：三叉神经痛 + 脉冲射频　；参考：《承德医学院》2017年硕士论文

【摘要】：目的:比较CT引导下脉冲射频作用于半月神经节对青年及老年三叉神经痛患者的临床疗效比较。并对通过脉冲射频作用的半月神经节在治疗青老年三叉神经患者的临床疗效进行对比,为以后临床治疗提供经验。方法:收集2015年6月至2016年6月这段时间就诊于天津二附属的三叉神经痛患者,这些患者一般都是原发性或者保守治疗无效的三叉神经痛患者。患者各脏器功能正常,脉冲射频治疗前未使用糖皮质激素(GCS)。青年三叉神经患者20例(A组),老年三叉神经痛患者20例(B组),两组患者分别进行脉冲射频治疗(60秒、3周期)。告知相关风险后,自愿行介入治疗,治疗前均签属手术同意书。入手术室之后让患者取仰卧位,肩部垫一薄枕高,使头度轻后仰,连接心电监护仪,建立上肢静脉通路。目标靶点为患侧的三叉神经半月神经节。先用直尺测出颧弓长度,并且通过刻度尺标记出中点,刻度尺量取患侧口角外侧2.5cm处并且向上1cm作为进针点,相当于上颌臼齿之上的颞弓下缘处,或相对第二上磨牙为穿刺点,0.5%利多卡因皮下局部麻醉后,7号10cm长穿刺针穿刺,针尖的方向在正面上观察对准瞳孔稍内侧,针尖的方向从侧面观察对准颧弓中点,缓慢进针,在CT引导下针尖到达卵圆孔半月神经节,给予局麻药试验,未发生局麻药无中毒反应。A组(青年三叉神经痛患者)患者进行脉冲射频(60秒、3周期),B组(老年三叉神经痛患者)患者进行脉冲射频(60秒、3周期)。脉冲射频治疗后让患者保持平卧位3h。A、B两组患者分别于术前后各时间段进行疼痛评分及睡眠质量评分,详细对术后患者进行临床疗效评估,计算出脉冲射频治疗的有效率。同时把后的并发症记录,并跟踪随访这些并发症的恢复情况。结果:1两组患者一般情况A组(青年患者):男性患者占7例,女性患者占13例;疼痛的病程在1.0~5.0个月,平均病程为2.6个月,患者年龄范围为30~40岁,平均患者年龄为32岁,疼痛范围为三叉神经Ⅱ支、Ⅱ和Ⅲ支或Ⅲ支。B组(老年患者):男性患者占8例,女性患者占12例;疼痛的病程在1.0~5.0个月,平均病程为2.65个月,患者年龄范围为60~70岁,平均患者年龄为63岁,疼痛范围为三叉神经Ⅱ支、Ⅱ和Ⅲ支或Ⅲ支。2两组患者脉冲射频治疗前疼痛评分及睡眠质量评分A组(青年患者)患者脉冲射频治疗前疼痛评分为7.10±0.79,睡眠质量评分为6.15±0.59;B组(老年患者)患者脉冲射频治疗前疼痛评分为7.00±0.73,睡眠质量评分为6.20±0.62;A组和B组脉冲射频治疗前疼痛评分及睡眠质量评分无明显差异(P0.05)。3两组患者脉冲射频治疗后疼痛评分及睡眠评分3.1两组脉冲射频治疗后疼痛评分A组(青年患者)脉冲射频治疗后各时间点的疼痛评分分别为4.10±0.64、2.75±0.72、2.35±0.59、2.10±0.64,脉冲射频治疗后各时间段疼痛评分明显低于术前(P0.01)。B组(老年患者)脉冲射频治疗后各时间点的疼痛评分分别为4.25±0.63、2.80±0.77、2.50±0.76、3.65±0.49,术后各时间段VAS评分与术前相比均显著性降低(P0.01)。A、B两组1周、1个月、3个月VAS评分未见显著性差异(P0.05)。A组治疗后6个月较B组治疗后6个月显著性降低(P0.01)。3.2两组术后SIS评分A组术后各时间点的SIS评分分别为4.20±0.62、2.34±0.49、2.05±0.69、2.05±0.61,脉冲射频治疗后各时间段睡眠质量评分与术前相比均显著性降低(P0.01)。B组术后各时间点的SIS评分分别为4.30±0.66、2.45±0.59、2.15±0.59、2.75±0.62,术后各时间段SIS评分与术前相比均显著性降低(P0.01)。A、B两组脉冲射频治疗后1周、1个月、3个月、6个月疼痛评分较术前均显著性降低(P0.01),A组治疗后6个月较B组治疗后6个月显著性降低。(P0.01)。4 A组、B组患者脉冲射频治疗后不同时间点有效率比较A组(青年患者)脉冲射频治疗后1周、1个月、3个月、6个月的有效率分别为91%、88%、83%、74%,B组(老年患者)脉冲射频治疗后1周、1个月、3个月、6个月的有效率分别为89%、86%、80%、70%。A、B两组T1、T2、T3有效率未见显著性差异(P0.05)。A组治疗后6个月时有效率较B组治疗后显著性升高(P0.01)。5术中及术后不良在脉冲射频治疗后患者出现高血压,经过降压等对症处理,心电监护实时监测,血压逐渐恢复正常,没有发生其他不适症状,其中A组(青年患者)有1例,B组(老年患者)2例。术后随访过程中穿刺部位局部肿胀的患者有3例,指导患者间断冰敷,肿胀常在术后很快的消除;手术治疗之后存在2为患者出现恶心、呕吐症状,考虑神经刺激引起,经过止吐治疗不适感觉得到改善。有1例患者出现患侧上眼睑上抬轻度受限,治疗后1月,上眼睑无力症状得到改善,治疗后3个月恢复正常。两组患者术后均未出现颅内血肿、感染、咀嚼肌无力等严重并发症。结论:CT引导下半月神经节脉冲射频治疗青年及老年三叉神经痛患者均安全有效,可明显缓解患者三叉神经分布区域的疼痛,改善患者睡眠质量。3月之内缓解疼痛方面两者未见明显差异,但治疗后6月青年患者优于老年三叉神经痛患者;改善睡眠质量方面3月之内两组未见明显差异,但治疗后6月青年患者优于老年三叉神经痛患者。半月神经节脉冲射频治疗三叉神经痛可以作为青年三叉神经痛患者的首选方法。
[Abstract]:Objective: To compare the clinical effect of CT guided pulsed radiofrequency on young and elderly trigeminal neuralgia in the treatment of young and elderly patients with trigeminal neuralgia, and compare the clinical effect of the pulsate radiofrequency ganglion in the treatment of the elderly with trigeminal nerve in the elderly, and provide experience for the future clinical treatment. Methods: collect from June 2015 to 2016. In June, the patients were diagnosed with trigeminal neuralgia in Tianjin II. These patients were usually patients with trigeminal neuralgia of primary or conservative treatment. The function of the patients was normal, GCS was not used before the pulse radiofrequency treatment. 20 cases of young trigeminal neuralgia (group A), and 20 cases of senile trigeminal neuralgia (B The two groups of patients were treated with pulse radio frequency therapy (60 seconds, 3 cycles). After informing the related risk, the patients were voluntarily involved in the intervention treatment, and all the patients signed the consent form before the treatment. After entering the operation room, the patients were given the supine position, the shoulder pads a thin pillow high, the head light back, the electrocardiogram monitor, and the upper limb venous access. The target target was the three fork of the affected side. Nerve semilunar ganglion. First use a ruler to measure the length of the zygomatic arch, and mark the middle point by the scale. The scale takes the lateral 2.5cm and 1cm as the needle point. It is equivalent to the lower edge of the temporomandibular arch above the maxillary molar, or the second upper molar is the puncture point. After 0.5% lidocaine subcutaneous local anaesthesia, 7 number 10cm long wear Needle puncture, the direction of the tip of the needle was observed at the middle of the pupil on the front. The direction of the needle point was observed at the middle point of the zygomatic arch from the side, and the needle was slowly entered. The needle tip reached the semilunar ganglion of the oval hole under the guidance of CT, and the local anesthetic test was given, and the patients of.A group (patients with young trigeminal neuralgia) did not take the pulse radiofrequency (60 Second, 3 cycles), B group (elderly trigeminal neuralgia patients) patients with pulse radio frequency (60 seconds, 3 cycles). Pulse radiofrequency treatment to keep the patients in the supine position 3h.A, B two groups of patients in each time of the pain score and sleep quality score, after the detailed clinical evaluation of postoperative patients, calculated the pulse radiofrequency treatment The postoperative complications were recorded and followed up. Results: 1 group A (young patients) in two groups: male and female 13; the course of pain was 1.0~5.0 months, the average course was 2.6 months, the age of the patient was 30~40, the average age was 32 years old and pain model. There were 8 cases of trigeminal nerve, II and III or III.B group (elderly patients): male patients accounted for 8 cases, female patients accounted for 12 cases, the course of pain was 1.0~5.0 months, the average course of disease was 2.65 months, the age range was 60~70 years, the average age was 63 years old, the pain range was trigeminal II Branch, II and III or III branch.2 two patients pulse Before radiofrequency treatment, pain score and sleep quality score in group A (young patients) were 7.10 + 0.79, and sleep quality was 6.15 + 0.59. The pain scores of patients in group B (elderly patients) were 7 + 0.73, and the sleep quality score was 6.20 + 0.62; A and B group before pulse radiofrequency treatment pain score And no significant difference in sleep quality score (P0.05) the pain score and sleep score after pulse radio frequency treatment in group.3 two were 3.1 two groups after pulse radiofrequency therapy in group A (young patients), the pain scores at each time point were 4.10 + 0.64,2.75 + 0.72,2.35 + 0.59,2.10 + 0.64 respectively after pulse radio frequency therapy, each time after pulse radio frequency therapy The pain score was significantly lower than that in group P0.01.B (P0.01) (elderly patients). The pain scores at each time point were 4.25 + 0.77,2.50 + 0.76,3.65 + 0.49 respectively. The VAS scores in each time period after the operation were significantly decreased (P0.01).A, B two groups 1 weeks, 1 months, 3 month VAS scores did not have significant difference (P0.05).A group treatment 6 months after treatment was significantly lower than that of group B (P0.01) after treatment (P0.01). The SIS score in group A after operation in group.3.2 two after operation was 4.20 + 0.62,2.34 + 0.49,2.05 + 0.61 respectively. The sleep quality score of each time period after pulse radio frequency treatment was significantly lower than that before operation (P0.01).B group. It was 4.30 + 0.66,2.45 + 0.59,2.15 + 0.59,2.75 + 0.62. The SIS scores in each time period were significantly lower than that before operation (P0.01).A. The pain scores in the B two groups were 1 weeks, 1 months, 3 months and 6 months were significantly lower than those before the operation (P0.01), and 6 months after the treatment in the A group were significantly lower than those of the B group for 6 months. The efficiency of group patients at different time points after radiofrequency treatment was compared in group A (young patients) after 1 weeks, 1 months, 3 months, 6 months, 91%, 88%, 83%, 74%, and group B (elderly patients) after pulse radio frequency therapy for 1 weeks, 1 months, 3 months, 6 months, respectively, 89%, 86%, 70%.A, B, T1, T2, T3 efficiency was not effective. The significant difference (P0.05) in group.A was significantly higher than that of group B (P0.01) after 6 months of treatment (P0.01) in.5 and postoperative patients with high blood pressure after pulse radiofrequency treatment, after decompression and other symptomatic treatment, real-time monitoring of ECG monitoring, the gradual recovery of blood pressure and no other discomfort symptoms, among which group A (young patients) There were 1 cases, group B (elderly patients) and 2 cases. There were 3 cases of local swelling in the puncture site during the follow-up. The patients were guided by intermittent ice compress, and the swelling was often eliminated quickly after the operation. After the operation, 2 of the patients had nausea, vomiting, nerve stimulation, and the treatment of discomfort improved. 1 patients appeared. The upper eyelid was slightly limited in the upper eyelid, and the upper eyelid weakness was improved in January after treatment. 3 months after treatment, the two groups had no intracranial hematoma, infection, and masticatory muscle weakness. Conclusion: CT guided radiofrequency for the second half of the month was safe and effective for the treatment of young and elderly trigeminal neuralgia. There was no significant difference in the pain of the trigeminal nerve distribution in the patients and the improvement of the sleep quality of the patients within.3 months. But in June, the young patients were better than the elderly patients with trigeminal neuralgia. There was no significant difference between the two groups in the improvement of sleep quality in March, but the young patients in June were better than the elderly three after the treatment. Trigeminal neuralgia can be used as the first choice for young patients with trigeminal neuralgia.

【学位授予单位】：承德医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R745.11

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