三叉神经痛颅外射频热凝舒适化治疗的流程与监护管理

陈栋樑; 仲俊峰; 黄兵; 张利; 任小妹; 姚明; 邓甲甲

doi:10.16766/j.cnki.issn.1674-4152.001751

三叉神经痛颅外射频热凝舒适化治疗的流程与监护管理

doi: 10.16766/j.cnki.issn.1674-4152.001751

1.
绍兴市人民医院疼痛科，浙江绍兴 312000
2.
嘉兴市第一医院疼痛科, 浙江嘉兴 314000

基金项目:

浙江省医药卫生平台计划项目 2016ZDA018

浙江省医药卫生科技计划项目 2019ZH046

嘉兴市重点科技项目 2018AY32010

详细信息

通讯作者:
黄兵，E-mail：jxhb999@sina.com

中图分类号: R747.2 R454
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- 被引次数: 0
出版历程
- 收稿日期: 2019-08-12
- 网络出版日期: 2022-02-19

Procedure and monitoring management of extracranial radiofrequency thermocoagulation for trigeminal neuralgia

1.
Department of Pain Medicine, The The First Hospital of Shaoxing, Shaoxing, Zhejiang 312000, China

摘要

摘要: 目的通过比较颅外非半月节射频热凝治疗三叉神经痛时局部麻醉与全凭静脉麻醉镇静镇痛效果, 以遴选最佳舒适化医疗流程与监护管理措施。方法将2018年1—10月从本课题组收治并确诊的150例三叉神经痛患者用随机数字表法随机分成甲、乙、丙3组, 每组各50例: 甲组除穿刺点局部麻醉外不再作任何麻醉干预; 乙、丙2组先静脉注射右美托咪啶0.3 μg/kg, 待穿刺成功电生理确认无误后, 乙组经射频针注入2%利多卡因0.5 mL, 5 min后开始射频热治疗; 丙组静脉注入丙泊酚1.0~1.5 mg/kg, 待患者入睡后再行射频治疗。根据术中血压、心率、血氧饱和度监测值变化给予乌拉地尔、麻黄碱、阿托品等相应血管活性药物以维持循环稳定。记录患者血压、心率及氧饱和度值及术中各药物用量, 以及术中并发症、术后近期疗效和患者满意度。结果甲组治疗期间血压、心率值均显著高于基础值, 且在穿刺操作(T1)和射频第60 s(T2)时点, 甲组血压、心率值与乙、丙2组升高, 差异有统计学意义(均P < 0.05)。甲组治疗期间有68%的患者需用血管活性药控制血压, 舒适化满意度丙组显著高于甲、乙2组(均P < 0.05)。结论颅外非半月节射频热凝治疗三叉神经痛时穿刺前给予右美托咪啶, 射频前静注适量丙泊酚可提高射频治疗的舒适度和满意度, 且不影响近期疗效判断, 但需吸氧、监护, 必要时使用血管活性药物维持循环稳定以策安全。
- 三叉神经痛 /
- 射频热凝 /
- 颅外非半月节
Abstract: Objective By comparing the effects of local anesthesia and total intravenous anesthesia in the treatment of trigeminal neuralgia by extracranial non-Gasserian ganglia radiofrequency thermocoagulation, the optimal comfortable medical process and monitoring management measures were selected. Methods A total of 150 patients with trigeminal neuralgia scheduled for radiofrequency thermocoagulation of extracranial non-Gasserian ganglia were randomly divided into three groups with random number table method: group A received no anesthetic intervention except local anesthesia at puncture point; The others received intravenous injection of dexmedetomidine (0.3 μg/kg), after electrophysiological tests were correct, group B received injection of 2% lidocaine 0.5 mL through radiofrequency needle; In group C, propofol was injected intravenously 1.0-1.5 mg/kg. Then radiofrequency therapy was performed after patients fell asleep. The corresponding vasoactive drugs such as urapidil, ephedrine and atropine were given to maintain circulation stability according to the changes of blood pressure, heart rate and oxygen saturation during operation. The blood pressure, heart rate, oxygen saturation, intraoperative dosage of drugs, intraoperative complications, short-term efficacy and patient satisfaction were recorded. Results Blood pressure and heart rate in group A were significantly higher than the baseline values during treatment, and at T1 (Puncture operation) and T2 (radiofrequency thermocoagulation 60 s), blood pressure and heart rate in group A were significantly higher than those in group B and C (all P < 0.05), respectively. 68% of patients in group A needed vasoactive drugs to control blood pressure during treatment, and comfort satisfaction in group C was significantly higher than those in group A and B (all P < 0.05). Conclusion When patients with trigeminal neuralgia are treated with extracranial radiofrequency thermocoagulation, dexmedetomidine injection before puncture and propofol injection before radiofrequency can greatly improve the comfort and satisfaction of radiofrequency therapy, without affecting the short-term efficacy judgement, but they need oxygen inhalation and monitoring, and use vasoactive drugs to maintain circulation stability when necessary to ensure safety.
- Trigeminal neuralgia /
- Radiofrequency thermocoagulation /
- Extracranial non-gasserian ganglia

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表 1 3组三叉神经痛患者的一般情况对比

组别	例数	性别(男/女，例)	年龄(x±s，岁)	侧别(左/右，例)	支别(Ⅴ1/Ⅴ2/Ⅴ3，例)	病程(x±s，月)	疼痛程度评分(x±s，分)	合并症(高血压，例)
甲组	50	17/33	68.0±12.8	23/27	8/25/17	30.7±18.4	7.08±1.35	7
乙组	50	19/31	68.0±12.9	16/34	9/24/17	30.9±18.1	7.12±1.27	11
丙组	50	20/30	66.9±14.1	15/35	6/25/19	31.2±18.5	6.90±1.30	9
统计量		0.399^a	0.123^b	3.299^a	2.063^a	0.008^b	0.398^b	0.014^a
P值		0.819	0.885	0.192	0.131	0.992	0.672	0.324
注：^a为χ²值，^b为F值。

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表 2 3组三叉神经痛患者治疗期间血压、心率变化(x ±s)

组别	例数	平均动脉压(mm Hg)			心率(次/min)
组别	例数	基础值	T1	T2	基础值	T1	T2
甲组	50	104.41±5.89	109.24±5.38^a	122.88±13.64^a	76.32±8.83	91.46±13.88^a	95.22±19.34^a
乙组	50	104.64±5.92	103.81±6.35^b	106.44±5.28^b	76.08±9.96	66.94±9.74^b	66.76±9.01^b
丙组	50	104.62±5.46	103.42±4.28^b	99.71±6.09^b	76.10±9.73	67.98±10.95^b	66.24±14.43^b
F值		0.027	18.196	84.926	0.031	78.032	66.857
P值		0.974	< 0.001	< 0.001	0.897	< 0.001	< 0.001
注：T1为穿刺到位时；T2为射频60 s时。与同组基础值比较，^aP < 0.05；与同时间点甲组比较，^bP < 0.05。

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表 3 术中需用药干预的高血压例数、术中术后并发症、疗效及满意度(例)

组别	例数	术中并发症					疗效满意情况			术后24 h舒适化满意度
组别	例数	需用药物干预的高血压例数	面部血肿	恶心呕吐	心梗	脑出血	术毕即刻	术后24 h	术后3个月	术后24 h舒适化满意度
甲组	50	34	15	3	0	0	50	50	50	5
乙组	50	16^a	9^a	5	0	0	50	47	50	11
丙组	50	6^a	9^a	2	0	0	50	50	50	49^ab
χ²值		34.422	2.797	1.500						92.742
P值		< 0.001	0.247	0.472						< 0.001
注：与甲组比较，^aP < 0.05；与乙组比较，^bP < 0.05。

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参考文献(26)

[1]	中华医学会神经外科学分会功能神经外科学组, 中国医师协会神经外科医师分会功能神经外科专家委员会, 北京医学会神经外科学分会, 等. 中国显微血管减压术治疗三叉神经痛和舌咽神经痛专家共识(2015)[J]. 中华神经外科杂志, 2017, 31(5): 217-220.
[2]	罗永香, 黄冰, 姚明, 等. 80岁以上高龄三叉神经痛患者的非半月节射频热凝治疗[J]. 中华全科医学, 2015, 13(5): 706-708, 758. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201505008.htm
[3]	黄冰, 陈雅静, 姚明, 等. 射频治疗三叉神经痛的临床进展[J]. 中国疼痛学杂志, 2019, 25(4): 289-291. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGQX202104013.htm
[4]	HUANG B, LUO Y X, CHEN Y J, et al. Progress in radiofrequency for trigeminal neuralgia: extracranial non-Gasserian ganglion radiofrequency thermocoagulation[J]. Med Sci Rev, 2019, 16(6): 1-6. http://www.researchgate.net/publication/331512347_Progress_in_Radiofrequency_for_Trigeminal_Neuralgia_Extracranial_Non-Gasserian_Ganglion_Radiofrequency_Thermocoagulation
[5]	黄冰, 陈栋樑, 冯智英, 等. 弯针技术在内向开口圆孔穿刺射频治疗三叉神经痛中的应用[J]. 中华神经外科杂志, 2018, 34(12): 1258-1262. doi: 10.3760/cma.j.issn.1001-2346.2018.12.015
[6]	HUANG B, XIE K Y, CHEN Y J, et al. Bipolar radiofrequency ablation of mandibular branch for refractory V3 trigeminal neuralgia[J]. J Pain Reserch, 2019. DOI: 10.2147/JPR.S197967.
[7]	黄冰, 冯智英, 占恭豪, 等. 颅外非半月节双极射频用于大卵圆孔三叉神经下颌支疼痛的效果[J]. 中华医学杂志, 2018, 98(38): 3102-3105. doi: 10.3760/cma.j.issn.0376-2491.2018.38.012
[8]	齐猛, 蒋丽丹, 孙澎, 等. 误诊为牙源性疼痛的三叉神经痛临床特点、鉴别诊断及治疗(附24例分析)[J]. 山东医药, 2017, 57(35): 83-86. doi: 10.3969/j.issn.1002-266X.2017.35.028
[9]	INOUE T, HIRAI H, SHIMA A, et al. Diagnosis and management for trigeminal neuralgia caused solely by venous compression[J]. Acta neurochirurgica, 2017, 159(4): 681-688. doi: 10.1007/s00701-017-3085-4
[10]	沈伟强, 张云, 沈健, 等. 3D-TOF MRA成像对三叉神经痛微血管压迫的诊断价值分析[J]. 浙江临床医学, 2017, 19(10): 1803-1805. https://www.cnki.com.cn/Article/CJFDTOTAL-CGZC201504014.htm
[11]	胡强, 俞文华, 杜权, 等. 微血管减压术治疗复发三叉神经痛临床疗效[J]. 浙江临床医学, 2018, 20(4): 608-610. https://www.cnki.com.cn/Article/CJFDTOTAL-GYYX201824011.htm
[12]	齐猛, 刘洋, 蒋丽丹, 等. 原发性三叉神经痛显微血管减压手术中责任病变的探查与分析[J]. 山东医药, 2017, 57(43): 1-4. doi: 10.3969/j.issn.1002-266X.2017.43.001
[13]	KEMENY A A. Long-term outcomes of microvascular decompression and Gamma Knife surgery for trigeminal neuralgia: a retrospective comparison study[J]. Acta Neurochirurgica, 2017, 159(11): 2137-2144. doi: 10.1007/s00701-017-3326-6
[14]	谢可越, 冯智英, 黄冰, 等. CT引导下经皮颧弓下入路穿刺至圆孔内与圆孔外口射频治疗三叉神经Ⅴ2支痛的临床效果比较[J]. 中华麻醉学杂志, 2018, 38(4): 341-343.
[15]	陈雅静, 黄冰, 姚明, 等. 射频穿刺针个体化塑形弯折器的制作与临床应用[J]. 中华全科医学, 2019, 17(3): 360-363.
[16]	褚丹涛, 陈雅静, 黄冰, 等. 卵圆孔最大横径及卵圆孔与棘孔距离的CT影像测量及其在三叉神经痛治疗中的应用[J]. 中华解剖与临床杂志, 2019, 24(1): 52-57.
[17]	仲勇, 林慧丹, 黄冰, 等. 颅外非半月节卵圆孔射频用于三叉神经下颌支疼痛的效果[J]. 中华神经医学杂志, 2019, 18(5): 528-530. doi: 10.3760/cma.j.issn.1671-8925.2019.05.016
[18]	董西安. 选择性射频热凝治疗三叉神经痛临床研究[J]. 中外医疗, 2017, 36(20): 97-99. https://www.cnki.com.cn/Article/CJFDTOTAL-HZZZ201720037.htm
[19]	李彦君, 张建新. 右美托咪定复合丙泊酚对高血压患者无痛胃镜检查应激反应及早期认知功能的影响[J]. 海南医学院学报, 2017, 23(17): 2445-2448. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYY201717036.htm
[20]	卢剑华. 右美托咪啶联合丙泊酚用于无痛胃镜检查的效果和安全性分析[J]. 现代消化及介入诊疗, 2017, 22(1): 80-82.
[21]	李爽, 高明, 潘奇正, 等. 右美托咪定用于老年患者无痛纤维肠镜息肉切除术的效果[J]. 中国老年学杂志, 2015, 35(19): 5566-5568. doi: 10.3969/j.issn.1005-9202.2015.19.091
[22]	曾雪云, 徐天生, 徐建光, 等. 右美托咪定复合丙泊酚用于无痛纤维结肠镜检查的临床疗效及安全性评价[J]. 中国临床药理学杂志, 2015, 31(10): 796-798. https://www.cnki.com.cn/Article/CJFDTOTAL-GLYZ201510009.htm
[23]	张振, 罗辉宇, 徐阳, 等. 丙泊酚分别复合盐酸纳布啡、地佐辛、舒芬太尼用于无痛胃镜的效果比较[J]. 中国药房, 2017, 28(3): 315-318. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYA201703008.htm
[24]	王振静, 孟宪慧. 小剂量舒芬太尼复合丙泊酚在无痛胃镜检查中的镇静效果及安全性[J]. 中华老年医学杂志, 2015, 34(8): 884-886.
[25]	任小妹, 沈秀华, 黄冰, 等. 原发性三叉神经痛颅外非半月节射频热凝治疗的护理[J]. 中华全科医学, 2017, 15(11): 1987-1989. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201711052.htm
[26]	潘莉娟, 黄冰, 任小妹, 等. 三叉神经颅外非半月节射频热凝治疗时危急事件的处理[J]. 中国急救复苏与灾害医学杂志, 2018, 14(7): 102-104.