Arasho Belachew, Sandu Nora, Spiriev Toma, Prabhakar Hemanshu, Schaller Bernhard
Department of Neurosurgery, University of Paris, France.
Neurol India. 2009 Jul-Aug;57(4):375-80. doi: 10.4103/0028-3886.55577.
The trigeminocardiac reflex (TCR) is defined as the sudden onset of parasympathetic dysrhythmia, sympathetic hypotension, apnea, or gastric hyper-motility during stimulation of any of the sensory branches of the trigeminal nerve. The proposed mechanism for the development of TCR is--the sensory nerve endings of the trigeminal nerve send neuronal signals via the Gasserian ganglion to the sensory nucleus of the trigeminal nerve, forming the afferent pathway of the reflex arc. It has been demonstrated that the TCR may occur with mechanical stimulation of all the branches of the trigeminal nerve anywhere along its course (central or peripheral). The reaction subsides with cessation of the stimulus. But, some patients may develop severe bradycardia, asystole, and arterial hypotension which require intervention. The risk factors already known to increase the incidence of TCR include: Hypercapnia; hypoxemia; light general anesthesia; age (more pronounced in children); the nature of the provoking stimulus (stimulus strength and duration); and drugs: Potent narcotic agents (sufentanil and alfentanil); beta-blockers; and calcium channel blockers. Because of the lack of full understanding of the TCR physiology, the current treatment options for patients with TCR include: (i) risk factor identification and modification; (ii) prophylactic measures; and (iii) administration of vagolytic agents or sympathomimetics.
三叉神经心脏反射（TCR）的定义为：在刺激三叉神经的任何感觉分支时，突然出现的副交感神经节律异常、交感神经低血压、呼吸暂停或胃蠕动亢进。TCR发生的推测机制是——三叉神经的感觉神经末梢通过半月神经节将神经信号发送至三叉神经感觉核，形成反射弧的传入通路。已经证实，在三叉神经各分支沿其行程的任何部位（中枢或外周）受到机械刺激时，都可能发生TCR。刺激停止后，反应消退。但是，一些患者可能会出现严重心动过缓、心搏停止和动脉低血压，需要进行干预。已知会增加TCR发生率的危险因素包括：高碳酸血症；低氧血症；浅全身麻醉；年龄（在儿童中更明显）；激发刺激的性质（刺激强度和持续时间）；以及药物：强效麻醉剂（舒芬太尼和阿芬太尼）；β受体阻滞剂；和钙通道阻滞剂。由于对TCR生理学缺乏全面了解，目前针对TCR患者的治疗选择包括：（i）识别并改变危险因素；（ii）预防措施；以及（iii）使用抗迷走神经药物或拟交感神经药物。
