目的 分析超声引导下翼腭窝神经阻滞对三叉神经痛经皮球囊压迫术患者术中的镇痛效果及安全性.方法 选取2021年3月-2023年3月安徽医科大学附属巢湖医院诊断为三叉神经痛需择期行经皮球囊压迫术患者104例,将上述患者以随机数字表法分为神经阻滞组(N组)和全身麻醉组(S组),每组52例.N组在常规全麻诱导前行超声引导下翼腭窝神经阻滞,S组诱导前不做特殊处理,所有患者均采用异丙酚全麻下置入喉罩进行麻醉诱导和维持,瑞芬太尼作为术中镇痛维持.比较两组入室后平静时(T0)、穿刺进入Meckle腔前(Ti)、穿刺进入Meckle腔时(T2)、球囊压迫三叉神经前(T3)、球囊压迫三叉神经时(T4)、入PACU苏醒后拔除喉罩时(T5)的平均动脉压(MAP)、心率(HR),以及BN1评分、NRS评分、炎症因子(TNF-α、IL-6)、拔管时间、术中追加使用舒芬太尼用量、乌拉地尔用量、阿托品用量.结果 N组T0~T4时MAP低于S组,差异有统计学意义(P<0.05),而两组T5时MAP比较,差异无统计学意义(P>0.05);N组术后6、12、24 h NRS评分均低于S组,差异有统计学意义(P<0.05),而两组术前术后BNI评分比较,差异无统计学意义(P>0.05);N组T2~T4时HR低于S组(P<0.05),而两组T0、T1、T5时HR比较,差异无统计学意义(P>0.05);N组术后TNF-a、IL-6水平低于S组,差异有统计学意义(P<0.05);N组术中追加使用舒芬太尼用量、乌拉地尔用量、阿托品用量及拔管时间少于S组,差异有统计学意义(P<0.05).结论 相较于常规全身麻醉,超声引导下翼腭窝神经阻滞联合全身麻醉在经皮球囊压迫术中可稳定三叉神经痛患者血流动力学,降低疼痛程度,减少术中辅助用药量,并缩短入PACU后拔管所需时间,值得临床应用.
Effect of Pterygopalatine Fossa Nerve Block on the Analgesic Effect of Percutaneous Balloon Compression for Trigeminal Neuralgia
Objective To analyze the analgesic effect and safety of ultrasound-guided pterygopalatine fossa nerve block in patients with trigeminal neuralgia undergoing percutaneous balloon compression.Methods From March 2021 to March 2023,104 patients with trigeminal neuralgia diagnosed in Chaohu Hospital of Anhui Medical University who underwent elective percutaneous balloon compression were selected.The above patients were divided into nerve block group(group N)and general anesthesia group(group S)by random number table method,with 52 patients in each group.In group N,ultrasound-guided pterygopalatine fossa nerve block was performed before induction of general anesthesia.In group S,no special treatment was performed before induction.All patients were placed in laryngeal mask under propofol general anesthesia for anesthesia induction and maintenance.Remifentanil was used as intraoperative analgesia maintenance.The mean arterial pressure(MAP),heart rate(HR)at the time of calm after entering the room(To),before puncture into the Meckle cavity(T1),when puncture into the Meckle cavity(T2),before balloon compression of the trigeminal nerve(T3),when balloon compression of the trigeminal nerve(T4),and when the laryngeal mask was removed after PACU recovery(T5),BNI score,NRS score,inflammatory factors(TNF-α,IL-6),extubation time,intraoperative sufentanil dosage,urapidil dosage and atropine dosage were compared between the two groups.Results MAP at T0-T4 in group N was lower than that in group S,the difference was statistically significant(P<0.05),but there was no significant difference in MAP and HR between the two groups at T5(P>0.05).HR at T2-T4 in group N was lower than that in group S(P<0.05),,but there was no significant difference in HR between the two groups at To,T[and T5(P>0.05).The NRS score at 6,12 and 24 h after operation in group N was lower than that in group S,the difference was statistically significant(P<0.05),but there was no significant difference in BNI score between the two groups before and after operation(P>0.05).The levels of TNF-a and IL-6 in group N were lower than those in group S,the difference was statistically significant(P<0.05).The additional dosage of sufentanil,urapidil,atropine and extubation time in group N were less than those in group S,the difference was statistically significant(P<0.05).Conclusion Compared with conventional general anesthesia,ultrasound-guided pterygopalatine fossa nerve block combined with general anesthesia can stabilize the hemodynamics of patients with trigeminal neuralgia during percutaneous balloon compression,reduce the degree of pain,reduce the amount of intraoperative adjuvant medication,and shorten the time required for extubation after entering PACU,which is worthy of clinical application.