三叉神经痛患者微血管减压术后卡马西平戒断反应的临床表现和原因分析  

Carbamazepine withdrawal reactions after neurovascular decompression for trigeminal neuralgia:the study of clinical presentation and possible etiology

作　　者：柴盈[1] 陈敏洁[1] 张伟杰[1] 张文豪[1] 王轶雯 魏文斌[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院·口腔医学院口腔外科,上海市口腔医学重点实验室,上海200011

出　　处：《中国口腔颌面外科杂志》2014年第5期412-415,共4页China Journal of Oral and Maxillofacial Surgery

基　　金：国家自然科学基金(81100824);上海交通大学医工交叉项目(YG2013MS59)~~

摘　　要：目的:研究三叉神经痛患者微血管减压术后卡马西平戒断反应的发生情况,并对可能的相关因素进行探讨。方法:对90例诊断为原发性三叉神经痛并行微血管减压术的患者手术前、后进行卡马西平血药浓度测定,观察术后临床表现,评估术后卡马西平戒断反应的发生情况,并对患者的一般情况(年龄、性别、病程),血管压迫情况(部位、程度),术中及术后情况(手术时间、术后疗效、并发症),卡马西平服药情况(服药时间、服药剂量、手术前、后卡马西平血药浓度、术后血药浓度降低值)各可能因素进行分析,采用SAS16.2软件包对结果进行χ2或Fisher检验。结果:术后卡马西平戒断反应的发生率为28.9%,戒断反应的症状主要包括失眠、烦躁、手足震颤、幻觉和剧烈头痛。术前有无卡马西平服用史(P=0.0001)、服药剂量(P=0.0277)和术后血药浓度下降多少(P=0.0213)与戒断反应的发生呈显著相关。结论:术前大剂量使用卡马西平和术后血药浓度大幅度下降,是导致发生三叉神经痛患者微血管减压术后出现卡马西平戒断反应的重要因素。PURPOSE： To study the presentations of carbamazepine-associated withdrawal reactions after microvascular decompression for trigeminal neuralgia, and to evaluate the probable factors. METHODS： The series included 90 patients diagnosed with classical trigeminal neuralgia. The carbamazepine serum level was tested twice pre- and post-operatively,clinical symptoms after operation were observed. The probable factors, including patients＇ general situation, the location and severity of vessel compression, intraoperative and postoperative condition, carbamazepine dosing condition were recorded and analyzed using Chi-square test or Fisher＇s exact test with SAS 16.2 software package. RESULTS： Among90 patients, twenty-six（28.9%） suffered from postoperative carbamazepine-associated withdrawal reactions after MVD.The symptoms of withdrawal reactions were overexcitement, e.g. insomnia, dysphonia, hand and foot fremitus, hallucination and severe headache. The history of carbamazepine therapy before MVD, preoperative dosage of carbamazepine, and the decrease value of carbamazepine blood concentrations demonstrated significant differences between patients with and without withdral reactions. CONCLUSIONS： Large preoperative dosage and high changing rate of pre- and post-operative carbamazepine blood concentrations are the important factors that may cause carbamazepine-associated withdrawal reactions.

关 键 词：卡马西平 戒断反应 微血管减压术 

分 类 号：R745.11[医药卫生—神经病学与精神病学]