原发性三叉神经痛脑干三叉神经诱发电位的临床应用研究

发布时间：2018-05-14 20:16

本文选题：三叉神经痛 + 脑干三叉神经诱发电位　；参考：《兰州大学》2017年硕士论文

【摘要】：目的建立及优化脑干三叉神经诱发电位(brain stem trigeminal evoked potentials,BTEP)的临床检测方法及BTEP的正常参考值,并以此为基础评价原发性三叉神经痛病人的BTEP变化及其与显微血管减压术疗效及并发症的相关性。方法以兰大二院2015年12月至2017年3月期间行BTEP监测的80例患者为研究对象,包括原发性三叉神经痛(Primary Trigeminal Neuralgia,PTN)25例、面肌痉挛(hemifacial spasm,HFS)50例、舌咽yL经痛(glossopharyngeal neuralgia,GPN)5例。首先将51例HFS和4例GPN患者随机分为导航组(30例)和徒手组(25例),分别刺激眶上神经、眶下神经和颏神经,检测并对比两种穿刺方法BTEP的出图率。同时测量BTEP W1、W2、W3的潜伏期及W2、W3的波幅,建立正常参考值。随后分别对25例实施显微血管减压术的PTN患者,记录其术前、术后患侧和健侧的BTEP指标并予以对比,结合临床进行综合评价。结果导航组和徒手组在眶上神经BTEP的引出率均较低(50%vs 18%),但导航组引出率明显较高(χ2=12.20,P0.05),眶下神经BTEP的引出率高且稳定(96.7%vs 88%),且应用导航后引出率有增高趋势,但无统计学显著性(χ2=3.04,P0.05),刺激颏神经后BTEP的引出率更低(16.7%vs 8%),即使应用导航后也未见提高(χ2=1.84,P0.05)。对25例PTN的研究结果显示三叉神经痛患者术前BTEP的W2、W3表现为潜伏期延长和(或)波形消失,与健侧BTEP比较有显著差异(P0.05),BTEP的变化与术后患者症状一致,术后23例病人三叉神经传导功能恢复,术后疼痛症状消失,无面部麻木,2例病人术后W2、W3波形未恢复,术后虽然面部疼痛症状消失,但出现面部麻木。结论刺激眶下神经,刺激强度在1mA~5 mA时,出图率高,且波形稳定。BTEP正常参考值的的建立,可进行原发性三叉神经痛的诊断;MVD后BTEP的W2、W3波的显著改善,支持血管压迫引起三叉神经痛的学说;BTEP有助于判断三叉神经传导功能有无异常,可用于指导手术避免神经损伤,评估减压是否充分,同时可对预后作出评价。
[Abstract]:Objective to establish and optimize the clinical detection method of brain stem trigeminal evoked potentialsof brainstem trigeminal evoked potential (BTEP) and the normal reference value of BTEP. To evaluate the changes of BTEP in patients with primary trigeminal neuralgia and its correlation with the efficacy and complications of microvascular decompression. Methods from December 2015 to March 2017, 80 patients underwent BTEP monitoring in the second Orchid University Hospital, including 25 patients with primary Trigeminal Neuralgiahe, 50 patients with hemifacial spasmosis, and 5 patients with glossopharyngeal yl glossopharyngeal neuralgia GPNs, including 25 patients with primary trigeminal neuralgia, 50 patients with hemifacial spasmosis and 5 patients with glossopharyngeal glossary neuralgia GPNs. First, 51 patients with HFS and 4 patients with GPN were randomly divided into navigation group (n = 30) and unarmed group (n = 25). The supraorbital nerve, suborbital nerve and mental nerve were stimulated, respectively. The imaging rate of BTEP was detected and compared. At the same time, the incubation period and amplitude of BTEP W1, W2 and W3 were measured, and the normal reference values were established. Subsequently, 25 cases of PTN patients undergoing microvascular decompression were recorded and compared with the BTEP indexes of the affected and healthy sides before and after the operation, and the comprehensive evaluation was carried out in combination with clinical practice. Results the extraction rate of BTEP in the supraorbital nerve in navigation group and barehanded group was lower than that in the control group (50 vs 18), but the extraction rate of BTEP in navigation group was significantly higher (蠂 ~ 2 / 12.20 / P0.05, P < 0.05). The extraction rate of BTEP in suborbital nerve was higher than that in control group (P < 0.05). The extraction rate of BTEP in suborbital nerve was higher than that in navigation group (P < 0.05). However, there was no statistical significance (蠂 ~ 2 / 3.04 / P _ (0.05). The extraction rate of BTEP after stimulation of mental nerve was lower than that after stimulation of mental nerve (蠂 ~ (2), and it was not improved even after the application of navigation (蠂 ~ (2) 1.84) (P ~ (0.05). The results of 25 cases of PTN showed that the W2T W3 of BTEP in patients with trigeminal neuralgia before operation was prolonged latency and / or waveform disappeared, there was significant difference compared with normal side BTEP. The trigeminal nerve conduction function was recovered in 23 patients after operation, and the symptoms of pain disappeared after operation, and the W2W3 waveform did not recover in 2 patients without facial numbness. Although the symptoms of facial pain disappeared after operation, the symptoms of facial numbness appeared. Conclusion when the stimulation intensity of the suborbital nerve is at 1mA~5 Ma, the imaging rate is high, and the normal reference value of the waveform is stable. The establishment of the normal reference value can improve the W2W3 wave of BTEP after the diagnosis of primary trigeminal neuralgia. Supporting the theory of trigeminal neuralgia caused by vascular compression BTEP is helpful to judge whether the trigeminal nerve conduction function is abnormal, to guide the operation to avoid nerve injury, to evaluate the adequacy of decompression, and to evaluate the prognosis.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.3

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