Department of Anaesthesiology, Shengjing Hospital of China Medical University.
Department of Anesthesiology.
J Neurosurg Anesthesiol. 2022 Jan 1;34(1):e40-e45. doi: 10.1097/ANA.0000000000000702.
Percutaneous compression of the trigeminal ganglion (PCTG) can induce significant hemodynamic perturbations secondary to the trigeminocardiac reflex (TCR). The aim of this study was to investigate the effect of atropine pretreatment on hemodynamic responses during PCTG for trigeminal neuralgia.
A total of 120 patients who received PCTG were randomly assigned to control and atropine groups that were pretreated with saline (n=60) and atropine 0.004 mg/kg intravenously (n=60), respectively. Heart rate (HR) and mean arterial pressure (MAP) were measured at 9 timepoints from before induction of anesthesia until the end of the PCTG procedure; the incidence of TCR was also observed.
HR was higher in the atropine compared with control group from the time of skin puncture with the PCTG needle until after the procedure was completed (P<0.05). MAP was also higher in the atropine compared with control group, but only at entry of the needle into the foramen ovale until 1 minute after trigeminal ganglion compression (P<0.05). HR was reduced in both groups during entry of the needle into the foramen ovale and during ganglion compression, but less so in the atropine compared with the control group (P<0.05). MAP increased during PCTG compared with baseline in both groups, but with a larger increase in the atropine group (P<0.05). Two and 52 cases in the control group, and 6 and 1 cases in the atropine group, exhibited a TCR during entry of the needle into the foramen ovale and at ganglion compression, respectively (P<0.05).
Pretreatment with atropine was effective in most patients at minimizing abrupt reduction in HR during PCTG.
经皮三叉神经节压迫（PCTG）可引起显著的血流动力学紊乱，这是由于三叉心动反射（TCR）的作用。本研究旨在探讨阿托品预处理对三叉神经痛患者行 PCTG 时血流动力学反应的影响。
共 120 例接受 PCTG 的患者被随机分为对照组和阿托品组，分别接受生理盐水（n=60）和阿托品 0.004mg/kg 静脉注射（n=60）预处理。从麻醉诱导前到 PCTG 操作结束，测量 9 个时间点的心率（HR）和平均动脉压（MAP）；还观察了 TCR 的发生率。
从皮肤穿刺用 PCTG 针开始到操作结束后，阿托品组的 HR 高于对照组（P<0.05）。与对照组相比，在针进入卵圆孔直至三叉神经节压迫后 1 分钟时，MAP 也较高（P<0.05）。两组在针进入卵圆孔和神经节压迫时 HR 均降低，但阿托品组比对照组降低幅度较小（P<0.05）。与基础值相比，两组在 PCTG 期间 HR 均升高，但阿托品组升高幅度更大（P<0.05）。对照组有 2 例和 52 例，阿托品组有 6 例和 1 例分别在针进入卵圆孔和神经节压迫时出现 TCR（P<0.05）。
在大多数患者中，阿托品预处理可有效减少 PCTG 时 HR 的突然下降。
