Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China.
Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China.
Clin Neurol Neurosurg. 2023 Aug;231:107834. doi: 10.1016/j.clineuro.2023.107834. Epub 2023 Jun 14.
The trigeminocardiac reflex (TCR) is a brainstem reflex commonly elicited during percutaneous balloon compression (PBC) for the treatment of trigeminal neuralgia (TN), which is characterized by drastic hemodynamic disturbances, such as bradycardia, arrhythmias and even cardiac arrest. In order to prevent catastrophic consequences, it is vital to screen the risk factors of TCR during perioperative period. The primary purpose of this study was to identify potential risk factors associated with TCR in patients with TN undergoing PBC, and to summarize the enlightenment of clinical anesthesia management.
The clinical data of 165 patients diagnosed with TN undergoing PBC from January 2021 to December 2021 were retrospectively analyzed. TCR was defined as a sudden decrease in heart rate of 20% or more compared with baseline, and / or cardiac arrest, coinciding with the stimulus of any branch of the trigeminal nerve. And a clear cause-effect relationship between heart rate reduction and PBC-related intervention was required. All demographic characteristics as well as surgical and anesthetic data were compared between TCR group and TCR-free group. Univariate and multivariate logistic regression analysis were used to further analyze TCR-related risk factors.
Of the 165 patients enrolled in this study, 73 (44.2%) were male and 92 (55.8%) were female, and the average age was 64.22 ± 9.72 years. The incidence of TCR in the patients with TN during PBC was 54.5%. The results of multivariate regression analysis indicated that the risk factor for TCR was heart rate < 60 beats/min immediately before foramen ovale puncture (OR: 4.622; 95%CI: 1.470-14.531; P < 0.05).
Heart rate < 60 beats/min immediately before foramen ovale puncture was independently associated with TCR. Therefore, it is necessary for anesthesiologists to raise heart rate appropriately to prevent TCR during PBC.
三叉心反射（TCR）是一种常见于经皮球囊压迫术（PBC）治疗三叉神经痛（TN）的脑干反射，其特征是出现剧烈的血流动力学紊乱，如心动过缓、心律失常，甚至心跳骤停。为了防止灾难性后果，在围手术期筛查 TCR 的危险因素至关重要。本研究的主要目的是确定接受 PBC 的 TN 患者中与 TCR 相关的潜在危险因素，并总结临床麻醉管理的启示。
回顾性分析 2021 年 1 月至 2021 年 12 月期间 165 例诊断为 TN 并接受 PBC 的患者的临床资料。TCR 定义为与基线相比心率下降 20%或更多，和/或出现心脏骤停，同时伴有三叉神经任何分支的刺激。并且需要明确心率降低与 PBC 相关干预之间的因果关系。比较 TCR 组和 TCR 无组之间的所有人口统计学特征以及手术和麻醉数据。使用单变量和多变量逻辑回归分析进一步分析 TCR 相关危险因素。
本研究共纳入 165 例患者，其中男性 73 例（44.2%），女性 92 例（55.8%），平均年龄 64.22±9.72 岁。在接受 PBC 的 TN 患者中，TCR 的发生率为 54.5%。多变量回归分析结果表明，卵圆孔穿刺前即刻心率<60 次/分是 TCR 的危险因素（OR：4.622；95%CI：1.470-14.531；P<0.05）。
卵圆孔穿刺前即刻心率<60 次/分与 TCR 独立相关。因此，麻醉医生有必要在 PBC 期间适当提高心率，以预防 TCR。
