清醒状态三叉神经节阻滞下CT引导经皮微球囊扩张压迫术治疗原发性三叉神经痛的安全性与疗效  

Efficacy and safety of CT-guided percutaneous microballoon compression in the treatment of patients with primary trigeminal neuralgia under conscious trigeminal ganglion local block

作　　者：任玉娥[1] 韩文彪 杜玉敏[1] 丛海静[1] 刘广召[1] Ren Yu'e;Han Wenbiao;Du Yumin;Cong Haijing;Liu Guangzhao(Department of Pain Management,the Second Hospital of Hebei Medical University,Shijiazhuang City,Hebei Province 050000,China)

机构地区：[1]河北医科大学第二医院疼痛科,石家庄050000

出　　处：《中华疼痛学杂志》2020年第1期30-35,共6页Chinese Journal Of Painology

摘　　要：目的评价在清醒状态三叉神经节阻滞下行微球囊扩张压迫术治疗原发性三叉神经痛的疗效和安全性。方法收集2019年5月至7月在河北医科大学第二医院疼痛科住院的原发性三叉神经痛患者68例,45~85岁,性别不限,视觉模拟评分(VAS)为7~10分,在CT引导下实施手术。患者术中清醒,术前缓慢静脉注射咪达唑仑0.03 mg/kg镇静。采用长10 cm的22 G局麻针穿刺,进入卵圆孔三叉神经节后注射1%利多卡因0.5 ml进行阻滞。之后沿局麻针内置入导丝,撤出局麻针,再沿导丝置入14号球囊导管针。然后推进到卵圆孔,沿球囊导管针置入4号Fogarty球囊导管,确认位置合适后,导管内注射碘海醇0.5~0.8 ml使末端球囊膨胀。CT扫描头颅侧位时调整球囊形状与位置,直至出现梨形影像,压迫2 min后退出。记录治疗前、穿刺针穿刺三叉神经节时、球囊压迫时与术后48 h的VAS评分,术中心率、血压变化情况及不良反应发生情况,并于术后3、6个月进行随访。结果所有患者手术过程均顺利。球囊压迫时VAS评分为(1.00±0.47)分,显著低于术前(8.00±0.50)分和穿刺局麻时(7.80±0.31)分,差异有统计学意义(P均<0.05)。术后48 h后VAS评分(0.80±0.11)分,比术前(8.00±0.50)分降低,差异有统计学意义(P<0.05)。局麻针穿刺三叉神经节阻滞时,收缩压、舒张压及心率均比入室时上升,差异均有统计学意义(P均<0.05)。球囊压迫时收缩压、舒张压及心率与入室相比差异无统计学意义(P均>0.05)。患者术后疼痛均缓解,未见严重并发症发生,随访时效果良好。结论清醒状态三叉神经节阻滞下CT引导经皮微球囊扩张压迫术治疗原发性三叉神经痛的效果可靠且操作安全。Objective To explore the efficacy and safety of percutaneous balloon compression(PBC)on trigeminal ganglion in the treatment of patients with primary trigeminal neuralgia(TN)under CT guidance and conscious trigeminal ganglion local block.Methods A total of 68 patients with TN was enrolled in this study,aged 45-85 years old,VAS 7-10,under conscious trigeminal ganglion block and CT-guidance from May to July 2019 in the Pain Department of Second Affiliated Hospital of Hebei Medical University.Low dose of intravenous midazolam(0.03 mg/kg)was usually administered for sedation,and the patients were awake and not intubated during the operation.A 22 gauge,10 cm needle for trigeminal ganglion block was performed with the injection of 1%lidocaine(0.5 ml)when being set smoothly through the ovale foramen by 3-D CT guidance.Then,a No.4 Fogarty balloon catheter was inserted through the canula,which was inflated by slowly injecting 0.5-0.8 ml of contrast media.The duration of compression was 2-3 min depending on the shape and volume of the inflated balloon with the surgeon attempting to obtain a pear shaped appearance of the balloon.VAS,blood pressure and HR were measured at four point times:preoperative,during the compression,and at 48 h after the operation,and follow-up at 3 and 6 months.Results There was no technical failure in this study,and a successful entry into foramen ovale was achieved in all cases.VAS was significantly lower at the balloon compression(1.00±0.47)than that before the operation(8.00±0.50)and during local anesthesia(7.80±0.31)(all P<0.05).VAS was lower at 48 h after the operation(0.80±0.11)than that before the operation(P<0.05).The systolic blood pressure,diastolic blood pressure and heart rate were significantly higher during trigeminal ganglion block with local anesthesia needle than those before the operation(all P<0.05).There was no significant difference in systolic pressure,diastolic pressure and heart rate at the times of balloon compression and before the operation.No significant complication

关 键 词：三叉神经痛 经皮微球囊压迫术 神经传导阻滞 三叉神经节 

分 类 号：R74[医药卫生—神经病学与精神病学]