Qin Qin, Wang Yaping
Department of Anesthesiology, Xiangya Second Hospital, Central South University, Changsha, Hunan.
Department of Anesthesiology, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China.
Medicine (Baltimore). 2020 Oct 30;99(44):e22467. doi: 10.1097/MD.0000000000022467.
Trigeminocardiac reflex (TCR) sometimes occurs during the percutaneous balloon compression (PBC) procedure to treat trigeminal neuralgia (TN), and it manifests as transient bradycardia or sinus arrest. However, recurrent intraoperative TCR cases are rarely reported. Meanwhile, the treatment for recurrent TCR is still unclear.
A 74-year-old male with a 2-year TN history could no longer tolerate the side effects of carbamazepine and came to seek PBC treatment.
Bradycardia or sinus arrest occurred repeatedly during the operation, and the heart rate (HR) rapidly returned to normal when the operation was suspended. The C-arm image showed the puncture needle entering the foramen ovale.
First, 0.5 mg atropine was administered twice, and then 1 mL of 2% lidocaine was injected locally at the puncture site. Finally, isoproterenol was continuously pumped and dynamically adjusted to maintain the HR above 90 bpm.
The use of atropine and lidocaine did not prevent the recurrence of TCR. The use of isoproterenol to maintain the HR enabled the successful completion of the operation. The patient recovered quickly after the operation and was discharged 2 days later. No complaints of discomfort were reported during the sixth-month follow-up.
The elimination of intraoperative TCR may be difficult. Maintaining a high HR intraoperatively by continuous isoproterenol infusion is effective for preventing or mitigating the onset of TCR.
经皮球囊压迫术（PBC）治疗三叉神经痛（TN）时有时会发生三叉神经心脏反射（TCR），表现为短暂性心动过缓或窦性停搏。然而，术中复发性TCR病例鲜有报道。同时，复发性TCR的治疗方法仍不明确。
一名74岁男性，有2年TN病史，无法再耐受卡马西平的副作用，前来寻求PBC治疗。
术中反复出现心动过缓或窦性停搏，手术暂停时心率（HR）迅速恢复正常。C形臂图像显示穿刺针进入卵圆孔。
首先，两次给予0.5毫克阿托品，然后在穿刺部位局部注射1毫升2%利多卡因。最后，持续泵入异丙肾上腺素并动态调整，以维持HR高于90次/分钟。
使用阿托品和利多卡因未能防止TCR复发。使用异丙肾上腺素维持HR使手术得以成功完成。患者术后恢复迅速，2天后出院。在6个月的随访中未报告不适主诉。
消除术中TCR可能困难。术中通过持续输注异丙肾上腺素维持较高HR对预防或减轻TCR发作有效。
