异丙肾上腺素在经皮微球囊压迫三叉神经术中的效果

Application of isoprenaline in the treatment of trigeminal ganglion with percutaneous balloon compression

中文关键词: 三叉神经痛  经皮微球囊压迫  异丙肾上腺素

英文关键词: Epileptiform neuralgia  Percutaneous microballoon compression  Isoproterenol

中文摘要:

      
目的 探讨异丙肾上腺素在三叉神经痛经皮微球囊压迫(percutaneous microballoon compression, PMC)中的效果。

方法 选择2016年5月至2017年12月连续收治的三叉神经痛行PMC的患者45例, 男25例, 女20例, 年龄47～70岁, ASA Ⅰ或Ⅱ级, 采用计算机随机数字表法随机分为两组: 研究组(n=23)插管后5 min泵注0.9%异丙肾上腺素0.6 μg·kg^-1·h^-1使HR增快至80次/分后开始手术穿刺;对照组(n=22)在HR慢于60次/分时给予阿托品0.5 mg静注。记录患者麻醉前(T0)、插管后5 min(T1)、穿刺开始时(T2)、球囊压迫半月神经节时(T3)、解除球囊压迫后5 min时(T4)的SBP、DBP和HR。计算两组患者SBP、DBP、HR在T2、T3时差值的绝对值, 分别记为△SBP、△DBP、△HR。记录术中窦性停搏和高血压的发生情况。

结果 T0、T1时两组SBP、DBP、HR差异无统计学意义。T2、T3时研究组HR明显快于对照组(P<0.05)。研究组△SBP、△DBP明显小于对照组(P<0.05)。对照组术中有2例窦性停博。研究组术中高血压发生率明显低于对照组[8（34.8%） vs 14(63.4%), P<0.05]。

结论 PMC术中使用异丙肾上腺素泵注, 与使用阿托品比较, 患者BP变化幅度更小,HR增快的幅度更大, 为球囊压迫时的HR骤降提供了更加安全的范围。

英文摘要:

      
Objective To investigate the application of isoproterenol in the operation of percutaneous microballoon compression (PMC).

Methods Forty-five patients with prosopalgia needed to be treated with PMC, 25 males and 20 females, aged 47-70 years, ASA physical status Ⅰ or Ⅱ, were selected from May 2016 to December 2017. The patients were randomly divided into two groups using computer random digital table: the control group (n = 22) was infused isoproterenol to increase the HR to 80 times every minute and to puncture, and the research group (n = 23) was given atropine 0.5 mg intravenously when HR was slower than 50 times every minute. The values of SBP, DBP and HR were recorded at the moment before anesthesia (T0), 5 minutes after intubation (T1), at the beginning of the puncture (T2), balloon compression and ganglion (T3) and 5 minutes after the balloon pressure (T4). The absolute value of difference of SBP, DBP and HR in the three groups were calculated at T2, T3, recorded as △SBP, △DBP and △HR. The incidents of sinus arrest and hypertension were recorded.

Results There was no significant difference of SBP, DBP and HR between the two groups at T0 and T1. Compared with the control group, the values of HR in the research group at T2, T3 were significant increased (P < 0.05). The values of △SBP and △DBP in the research group were significantly lower than those in the control group (P < 0.05). There were 2 cases of sinus arrest in the control group. The incidence of hypertension in the research group was significantly lower than that in the control group [8 (34.8%) vs 14 (63.4%), P < 0.05].

Conclusion Compared with the use of atropine alone, isoproterenol used in PMC makes blood pressure change less and more stable and allows patients to increase heart rate. This method provides a safer range for heart rate drop during the balloon compression.