立体定向射频热凝治疗三叉神经痛的心血管反应  

Cardiovascular responses during stereotactic assisted percutaneous radiofrequency thermocoagulation therapy for primary trigeminal neuralgia

作　　者：林劲芝[1] 王墨[1] 罗唯师[1] 张相[1] 罗国轩[1] 孙晓辉[1] 张勇[1] 

机构地区：[1]广东省第二人民医院神经外科,广东广州510317

出　　处：《中华神经外科疾病研究杂志》2014年第1期67-71,共5页Chinese Journal of Neurosurgical Disease Research

摘　　要：目的探讨立体定向导航下经皮穿刺射频热凝术治疗三叉神经痛中,对心血管所产生的副作用。方法对256原发性三叉神经痛患者采用立体定向导航技术对三叉神经半月节进行经皮穿刺热凝毁损,术中全程监测患者的心率、血压及心电图。结果所有256例(100%)患者进行射频毁损治疗中均出现不同程度的心率及血压的升高,静脉应用硝酸甘油调控效果良好。在穿刺卵圆孔过程中有22例(8.6%)患者出现即时的不同程度的心率和血压的降低(最低心率<60次/min有12例(4.7%),最低心率≥60次/min有10例(3.9%),对心率下降但心率≥60次/min的患者采用立刻终止手术操作,患者心率可以逐渐好转。对心率下降并且心率<60次/min的患者静脉注射阿托品干预后,患者心率能恢复正常。结论经皮穿刺半月节射频热凝术治疗三叉神经痛,术中进行持续的心电监测可以实时了解心率及血压变化,立即予以停止手术操作和药物干预可以有效避免严重心血管事件的发生。Objective To investigate cardiovascular side effects of stereotactic assisted radiofrequency thermocoagulation for the primary trigeminal neuralgia. Methods A total of 256 patients with primary trigeminal neuralgia were treated with stereotactie assisted percutaneous radiofrequeney thermocoagulation. Continuous heart rate, blood pressure and electrocardiogram were monitored during the procedure of oval foramen puncture and lesion production. Results All of 256 patients appeared heart rate and blood pressure increases during lesion treatment, and it could resume normal Level through intravenous nitroglycerin. Oval foramen ptmcture led to the decrease of heart rate and blood pressure immedilately in 22 patients （8. 6% ）, minimum heart rate under 60 bpm in 12 patients （4.7%） and minimum heart rate over 60 bpm in 10 patients （3.9%）. Twelve patients who had mininaan heart rate over 60 bpm could resume normal heart rate immediately after the operation terminated. Ten patients who had mininmm heart rate under 60 bpm could resume normal heart rate by intravenous atropine injection immediately. Conclusion Continuing electrocardiogram monitoring is helpful to know the real-time heart rate and blood pressure changes. Proper surgery tenon and drug intervention can avoid the occurrence of serious cardiovascular events effectively during the procedures of percutaneous radiofrequency thermocoagulafion therapy for primary trigeminal neuralgia.

关 键 词：三叉神经痛 立体定向导航 射频热凝 心率 血压 

分 类 号：R651.3[医药卫生—外科学]