区域麻醉下三叉神经半月节球囊压迫术治疗三叉神经痛的安全性及有效性分析

Analysis of the safety and efficacy of percutaneous balloon compression of trigeminal ganglion under regional anesthesia in the treatment of trigeminal neuralgia

摘要:

目的：探讨区域麻醉下三叉神经半月节球囊压迫术对三叉神经痛(Trigeminal neuralgia, TN)治疗的安全性和有效性。方法：回顾性分析2022年1-12月于首都医科大学宣武医院疼痛科接受区域麻醉下三叉神经半月节球囊压迫术(percutaneous balloon compression, PBC)的60例患者临床资料。比较术中入室局麻前(T0)、三叉神经节阻滞时(T1)、阻滞退针后(T2)、穿刺针进入卵圆孔时(T3)、球囊压迫时(T4)和解除压迫后3min(T5)的平均动脉压(MAP)、心率(HR),并统计三叉-心脏反射(Trigemino-cardiac reflex, TCR)情况；比较术前和术后1天、7天、1月、3月、6月、12月的数字评定量表(NRS)、主观面部麻木等级、浅感觉减退评级、咀嚼肌力评级,以及术后12月的口服镇痛药减少情况、患者满意度、Macnab评分和不良反应情况。结果：T3、T4时HR较基线明显波动(P<0.05)； T4、T5时MAP 较基线明显波动(P<0.05)。术后NRS评分明显降低且长期有效(P术前:12m<0.05)；术后1天-3月,主观面部麻木及浅感觉减退均明显(P <0.05),V1分布区面部麻木及浅感觉减退于术后6月出现明显恢复且几近术前水平(P术前:6m>0.05),V2在术后3月时出现明显恢复,于术后12月时麻木评级与术前无显著性差异(P术前:12m>0.05),浅感觉减退评级下降仍明显(P术前:12m < 0.05)；V3于术后6月时明显恢复,术后12月时均恢复至术前水平(P术前:12m>0.05)；术后12月时,91.67%的患者口服镇痛药减少≥50%,85%的患者认为疗效符合预期。结论：区域麻醉下PBC治疗TN安全有效,术中血流动力学稳定,术后长期有效率及患者满意度高。

Abstract:

OBJECTIVE：To investigate the safety and efficacy of Percutaneous balloon compression (PBC) of trigeminal ganglion under regional anesthesia for the treatment of trigeminal neuralgia (TN). METHODS: The clinical data of 60 patients who underwent PBC of trigeminal ganglion under regional anesthesia at the Pain Department of Xuanwu Hospital of Capital Medical University from January to December 2022 were retrospectively analyzed. Mean arterial pressure (MAP) and heart rate (HR) before local anesthesia (T0), at the time of trigeminal ganglion block (T1), after the block was withdrawn from the needle (T2), at the time when the puncture needle was entering the foramen ovale (T3), at the time of balloon compression (T4), and 3 min after the release of the compression (T5) were cpmpared, and statistic events of trigeminocardiac reflex (TCR ); and comparing preoperative and postoperative numerical rating scale (NRS) for pain, Subjective facial numbness and superficial hyperalgesia were significant from 1 day to 3 months postoperatively (P < 0.05), facial numbness and superficial hyperalgesia in the distribution area of V1 showing a significant recovery at 6 months postoperatively and approaching the preoperative level (Ppre-op:6m > 0.05), V2 appeared to have recovered significantly at 3 months postoperatively, and the numbness ratings were not significantly different from the preoperative level at 12 months postoperatively (Ppre-op:12m > 0.05), and the superficial hyperalgesia hypesthesia ratings remained significant (Ppre-op:12m < 0.05); V3 showed significant recovery at 6 months postoperatively, and all returned to preoperative levels at 12 months postoperatively (P pre-op-:12m > 0.05) ;At 12 months postoperatively, 91.67% of patients had a ≥50% reduction in oral analgesics, and 85% felt that the efficacy was as expected. CONCLUSION: PBC under regional anesthesia is safe and effective for the treatment of TN, with stable and long-term intraoperative hemodynamics and high patient satisfaction.