围手术期应用尼莫地平对原发性面肌痉挛微血管减压术后并发症的疗效分析

发布时间：2018-12-19 07:14

【摘要】：目的:面肌痉挛常表现为单侧面部肌肉不自主抽搐,目前首选的外科治疗手段为乙状窦后入路微血管减压术。但小脑桥脑角区解剖结构复杂,责任血管常与面神经纠结伴行,游离时易因牵拉而对其造成刺激甚至损伤,导致术后相关并发症的产生,如头痛、头晕、听力下降、面瘫等。尼莫地平作为钙离子通道阻滞剂,具有缓解血管痉挛及改善脑循环的作用。本文观察围手术期应用尼莫地平与否对预防和缓解原发性面肌痉挛患者微血管减压术后并发症的疗效,并对数据进行统计学分析。方法:对我院2014年1月至2016年10月共90例面肌痉挛患者,随机分为2组,治疗组与对照组各45例,均行微血管减压手术治疗。两组患者一般情况无明显差异,均为单侧发病,行MRI检查明确诊断并排除占位性病变。术前听力正常,无头晕、头痛、面瘫等症状。两组患者术后均给予相同治疗方案,其中治疗组患者在围手术期加用尼莫地平,术前1日起静脉泵入尼莫地平注射液0.8mg/h,连用5日,后改为口服尼莫地平片2周60mg Q4h。术后随访至少6个月。结果:82例患者术后面肌痉挛症状即刻消失,术后即刻有效率91.1%,其余患者术后症状均明显改善。其中5例患者术后7日内症状消失,其余3例患者在随访1-3个月中症状均消失。总体有效率100.0%。其中治疗组患者术后发热11例,头痛12例,头晕7例,迟发性面瘫2例,听力下降4例,脑脊液漏1例;对照组患者发热12例,头痛14例,头晕15例,迟发性面瘫8例,听力下降11例,脑脊液漏1例。全部患者均未出现颅内感染、脑干梗死等并发症。除对照组1例遗留轻度耳鸣外,至随访末期其余患者并发症均已恢复,其中治疗组并发症程度及恢复时间均明显优于对照组。结论:1、微血管减压术治疗原发性面肌痉挛效果满意,安全性高;2、围手术期应用尼莫地平可减少术后头晕、听力下降、迟发性面瘫等并发症的发生率,并缩短其恢复时间;3、围手术期应用尼莫地平对术后发热、头痛、脑脊液漏等并发症无明显疗效。
[Abstract]:Objective: hemifacial spasm is often characterized by unilateral facial muscle involuntary convulsion. The preferred surgical treatment is retrosigmoid sinus microvascular decompression. However, the anatomical structure of cerebellopontine angle area is complex, the responsible blood vessels are often accompanied by facial nerve entanglement, and it is easy to cause stimulation and even injury due to traction when dissociating, resulting in the occurrence of postoperative complications, such as headache, dizziness, hearing loss, facial paralysis and so on. As a calcium channel blocker, nimodipine can relieve vasospasm and improve cerebral circulation. The effect of nimodipine on preventing and relieving complications after microvascular decompression in patients with primary hemifacial spasm was observed. Methods: from January 2014 to October 2016, 90 patients with hemifacial spasm in our hospital were randomly divided into two groups: treatment group (n = 45) and control group (n = 45). There was no significant difference between the two groups in general, both of them were unilateral. MRI was performed to diagnose and exclude the space occupying lesions. Preoperative hearing normal, no dizziness, headache, facial paralysis and other symptoms. The patients in the treatment group were treated with nimodipine plus nimodipine during the perioperative period. The patients in the treatment group were injected with nimodipine injection 0.8mg / h 1 day before operation for 5 days, and then treated with nimodipine tablets for 2 weeks 60mg Q4 h. All patients were followed up for at least 6 months. Results: the symptoms of hemifacial spasm disappeared immediately and the effective rate was 91.1%. The symptoms of 5 patients disappeared within 7 days after operation, and the other 3 patients disappeared during 1-3 months follow-up. The overall effective rate is 100.0. In the treatment group, there were 11 cases of fever, 12 cases of headache, 7 cases of dizziness, 2 cases of delayed facial paralysis, 4 cases of hearing loss and 1 case of cerebrospinal fluid leakage. In the control group, there were 12 cases of fever, 14 cases of headache, 15 cases of dizziness, 8 cases of delayed facial paralysis, 11 cases of hearing loss and 1 case of cerebrospinal fluid leakage. All the patients had no complications such as intracranial infection, brainstem infarction and so on. The complications of the treatment group were significantly better than that of the control group except for one case of mild tinnitus left in the control group by the end of follow-up. Conclusion: 1. Microvascular decompression is effective and safe in the treatment of primary hemifacial spasm. 2Perioperative application of nimodipine can reduce the incidence of complications such as dizziness, hearing loss and delayed facial paralysis, and shorten the recovery time. 3. There was no obvious effect of nimodipine on postoperative fever, headache, cerebrospinal fluid leakage and other complications.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.3

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