区域麻醉下三叉神经节球囊压迫术的安全性和有效性分析  

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

作　　者：卢洁[1] 程余意 王宏岩 何亮亮[1] 窦智[1] 杨立强[1] LU Jie;CHENG Yu-yi;WANG Hong-yan;HE Liang-liang;DOU Zhi;YANG Li-qiang(Department of Pain Management,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Anesthesia,Maanshan People's Hospital,Maanshan 243000,China)

机构地区：[1]首都医科大学宣武医院疼痛科,北京100053 [2]马鞍山市人民医院麻醉科,马鞍山243000

出　　处：《中国疼痛医学杂志》2025年第2期102-109,共8页Chinese Journal of Pain Medicine

基　　金：首都卫生发展科研专项(首发2024-2-20111);北京市医院管理中心扬帆计划(ZYLX202134)。

摘　　要：目的:探讨区域麻醉下三叉神经半月节球囊压迫术(percutaneous balloon compression,PBC)治疗三叉神经痛的安全性和有效性。方法:回顾性分析2022年1月至2023年6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PBC治疗的80例三叉神经痛病人的临床资料。比较入室局部麻醉前(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)、解除压迫后3 min(T5)的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR),并统计三叉-心脏反射(trigemino-cardiac reflex,TCR)情况;比较术前和术后1、7天、1、3、6、12个月的疼痛数字分级评分法(numerical rating scale,NRS)评分、主观面部麻木分级、浅感觉减退评级、咀嚼肌力评级,以及术后12个月的口服镇痛药减少情况、病人满意度、MacNab评分和不良反应情况。结果:与基线相比,所有病人在T3、T4时HR出现明显波动,在T4、T5时MAP明显波动,在T4时出现TCR 1例,总体术后NRS评分较术前明显降低且长期有效;咀嚼肌乏力于术后3个月时基本恢复至术前水平。所有病人在术后1天至3个月期间存在主观面部麻木及浅感觉明显减退,V1及V3区域于术后6个月出现明显恢复趋势,术后12个月时恢复至术前水平;V2区域在术后3个月时出现明显恢复,于术后12个月时均未能完全恢复。术后12个月时,92.5%的病人口服镇痛药减少≥50%,85%的病人认为疗效符合预期。结论:区域麻醉下PBC治疗三叉神经痛安全有效,术中血流动力学稳定,术后长期有效率及病人满意度高。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 80 patients who treated with PBC of trigeminal ganglion under regional anesthesia at the Pain Department of Xuanwu Hospital of Capital Medical University from January 2022 to June 2023 were retrospectively analyzed.Mean arterial pressure(MAP)and heart rate(HR)were compared before local anesthesia(T0)with during trigeminal ganglion block(T1),after the block needle was withdrawn(T2),at the time of puncture needle entry into the foramen ovale(T3),during the time of balloon compression(T4),and at 3 min after the release of compression(T5),and the events of trigeminocardiac reflex(TCR)were record.The numerical rating scale(NRS)scores for pain,subjective facial numbness ratings,superficial hypoesthesia ratings,and masticatory muscle strength ratings of patients before operation were compared with that on the 1st day,the 7th day,the 1st month,the 3rd month,the 6th month and the 12th month after surgery.As well as reductions in oral analgesia,patient satisfaction,MacNab scores,and adverse events at 12th month after surgery were collected and calculated.Results:Compared with baseline,all patients showed significant fluctuations in HR at T3 and T4,and in MAP at T4 and T5,there was one case of TCR at T4.Their postoperative NRS scores were significantly lower than preoperative counterparts and were effective in the long term.Masticatory muscle weakness returned to the preoperative level at 3 months postoperatively.Subjective facial numbness and significant loss of light sensation between 1 day and 3 months postoperatively in almost all patients,in the distribution area of V1 and V3 appeared to have recovered significantly at 6 months postoperatively,and recovered to the preoperative level at 12 months postoperatively;V2 appeared to have recovered significantly at 3 months postoperatively,but did not recover complet

关 键 词：三叉神经痛 球囊压迫 区域麻醉 

分 类 号：R614[医药卫生—麻醉学]