發(fā)布時(shí)間：2018-04-30 15:09

  本文選題：三叉神經(jīng)痛 + 脈沖射頻��； 參考：《承德醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:比較CT引導(dǎo)下脈沖射頻作用于半月神經(jīng)節(jié)對(duì)青年及老年三叉神經(jīng)痛患者的臨床療效比較。并對(duì)通過脈沖射頻作用的半月神經(jīng)節(jié)在治療青老年三叉神經(jīng)患者的臨床療效進(jìn)行對(duì)比,為以后臨床治療提供經(jīng)驗(yàn)。方法:收集2015年6月至2016年6月這段時(shí)間就診于天津二附屬的三叉神經(jīng)痛患者,這些患者一般都是原發(fā)性或者保守治療無效的三叉神經(jīng)痛患者�；颊吒髋K器功能正常,脈沖射頻治療前未使用糖皮質(zhì)激素(GCS)。青年三叉神經(jīng)患者20例(A組),老年三叉神經(jīng)痛患者20例(B組),兩組患者分別進(jìn)行脈沖射頻治療(60秒、3周期)。告知相關(guān)風(fēng)險(xiǎn)后,自愿行介入治療,治療前均簽屬手術(shù)同意書。入手術(shù)室之后讓患者取仰臥位,肩部墊一薄枕高,使頭度輕后仰,連接心電監(jiān)護(hù)儀,建立上肢靜脈通路。目標(biāo)靶點(diǎn)為患側(cè)的三叉神經(jīng)半月神經(jīng)節(jié)。先用直尺測出顴弓長度,并且通過刻度尺標(biāo)記出中點(diǎn),刻度尺量取患側(cè)口角外側(cè)2.5cm處并且向上1cm作為進(jìn)針點(diǎn),相當(dāng)于上頜臼齒之上的顳弓下緣處,或相對(duì)第二上磨牙為穿刺點(diǎn),0.5%利多卡因皮下局部麻醉后,7號(hào)10cm長穿刺針穿刺,針尖的方向在正面上觀察對(duì)準(zhǔn)瞳孔稍內(nèi)側(cè),針尖的方向從側(cè)面觀察對(duì)準(zhǔn)顴弓中點(diǎn),緩慢進(jìn)針,在CT引導(dǎo)下針尖到達(dá)卵圓孔半月神經(jīng)節(jié),給予局麻藥試驗(yàn),未發(fā)生局麻藥無中毒反應(yīng)。A組(青年三叉神經(jīng)痛患者)患者進(jìn)行脈沖射頻(60秒、3周期),B組(老年三叉神經(jīng)痛患者)患者進(jìn)行脈沖射頻(60秒、3周期)。脈沖射頻治療后讓患者保持平臥位3h。A、B兩組患者分別于術(shù)前后各時(shí)間段進(jìn)行疼痛評(píng)分及睡眠質(zhì)量評(píng)分,詳細(xì)對(duì)術(shù)后患者進(jìn)行臨床療效評(píng)估,計(jì)算出脈沖射頻治療的有效率。同時(shí)把后的并發(fā)癥記錄,并跟蹤隨訪這些并發(fā)癥的恢復(fù)情況。結(jié)果:1兩組患者一般情況A組(青年患者):男性患者占7例,女性患者占13例;疼痛的病程在1.0~5.0個(gè)月,平均病程為2.6個(gè)月,患者年齡范圍為30~40歲,平均患者年齡為32歲,疼痛范圍為三叉神經(jīng)Ⅱ支、Ⅱ和Ⅲ支或Ⅲ支。B組(老年患者):男性患者占8例,女性患者占12例;疼痛的病程在1.0~5.0個(gè)月,平均病程為2.65個(gè)月,患者年齡范圍為60~70歲,平均患者年齡為63歲,疼痛范圍為三叉神經(jīng)Ⅱ支、Ⅱ和Ⅲ支或Ⅲ支。2兩組患者脈沖射頻治療前疼痛評(píng)分及睡眠質(zhì)量評(píng)分A組(青年患者)患者脈沖射頻治療前疼痛評(píng)分為7.10±0.79,睡眠質(zhì)量評(píng)分為6.15±0.59;B組(老年患者)患者脈沖射頻治療前疼痛評(píng)分為7.00±0.73,睡眠質(zhì)量評(píng)分為6.20±0.62;A組和B組脈沖射頻治療前疼痛評(píng)分及睡眠質(zhì)量評(píng)分無明顯差異(P0.05)。3兩組患者脈沖射頻治療后疼痛評(píng)分及睡眠評(píng)分3.1兩組脈沖射頻治療后疼痛評(píng)分A組(青年患者)脈沖射頻治療后各時(shí)間點(diǎn)的疼痛評(píng)分分別為4.10±0.64、2.75±0.72、2.35±0.59、2.10±0.64,脈沖射頻治療后各時(shí)間段疼痛評(píng)分明顯低于術(shù)前(P0.01)。B組(老年患者)脈沖射頻治療后各時(shí)間點(diǎn)的疼痛評(píng)分分別為4.25±0.63、2.80±0.77、2.50±0.76、3.65±0.49,術(shù)后各時(shí)間段VAS評(píng)分與術(shù)前相比均顯著性降低(P0.01)。A、B兩組1周、1個(gè)月、3個(gè)月VAS評(píng)分未見顯著性差異(P0.05)。A組治療后6個(gè)月較B組治療后6個(gè)月顯著性降低(P0.01)。3.2兩組術(shù)后SIS評(píng)分A組術(shù)后各時(shí)間點(diǎn)的SIS評(píng)分分別為4.20±0.62、2.34±0.49、2.05±0.69、2.05±0.61,脈沖射頻治療后各時(shí)間段睡眠質(zhì)量評(píng)分與術(shù)前相比均顯著性降低(P0.01)。B組術(shù)后各時(shí)間點(diǎn)的SIS評(píng)分分別為4.30±0.66、2.45±0.59、2.15±0.59、2.75±0.62,術(shù)后各時(shí)間段SIS評(píng)分與術(shù)前相比均顯著性降低(P0.01)。A、B兩組脈沖射頻治療后1周、1個(gè)月、3個(gè)月、6個(gè)月疼痛評(píng)分較術(shù)前均顯著性降低(P0.01),A組治療后6個(gè)月較B組治療后6個(gè)月顯著性降低。(P0.01)。4 A組、B組患者脈沖射頻治療后不同時(shí)間點(diǎn)有效率比較A組(青年患者)脈沖射頻治療后1周、1個(gè)月、3個(gè)月、6個(gè)月的有效率分別為91%、88%、83%、74%,B組(老年患者)脈沖射頻治療后1周、1個(gè)月、3個(gè)月、6個(gè)月的有效率分別為89%、86%、80%、70%。A、B兩組T1、T2、T3有效率未見顯著性差異(P0.05)。A組治療后6個(gè)月時(shí)有效率較B組治療后顯著性升高(P0.01)。5術(shù)中及術(shù)后不良在脈沖射頻治療后患者出現(xiàn)高血壓,經(jīng)過降壓等對(duì)癥處理,心電監(jiān)護(hù)實(shí)時(shí)監(jiān)測,血壓逐漸恢復(fù)正常,沒有發(fā)生其他不適癥狀,其中A組(青年患者)有1例,B組(老年患者)2例。術(shù)后隨訪過程中穿刺部位局部腫脹的患者有3例,指導(dǎo)患者間斷冰敷,腫脹常在術(shù)后很快的消除;手術(shù)治療之后存在2為患者出現(xiàn)惡心、嘔吐癥狀,考慮神經(jīng)刺激引起,經(jīng)過止吐治療不適感覺得到改善。有1例患者出現(xiàn)患側(cè)上眼瞼上抬輕度受限,治療后1月,上眼瞼無力癥狀得到改善,治療后3個(gè)月恢復(fù)正常。兩組患者術(shù)后均未出現(xiàn)顱內(nèi)血腫、感染、咀嚼肌無力等嚴(yán)重并發(fā)癥。結(jié)論:CT引導(dǎo)下半月神經(jīng)節(jié)脈沖射頻治療青年及老年三叉神經(jīng)痛患者均安全有效,可明顯緩解患者三叉神經(jīng)分布區(qū)域的疼痛,改善患者睡眠質(zhì)量。3月之內(nèi)緩解疼痛方面兩者未見明顯差異,但治療后6月青年患者優(yōu)于老年三叉神經(jīng)痛患者;改善睡眠質(zhì)量方面3月之內(nèi)兩組未見明顯差異,但治療后6月青年患者優(yōu)于老年三叉神經(jīng)痛患者。半月神經(jīng)節(jié)脈沖射頻治療三叉神經(jīng)痛可以作為青年三叉神經(jīng)痛患者的首選方法。
[Abstract]:Objective: To compare the clinical effect of CT guided pulsed radiofrequency on young and elderly trigeminal neuralgia in the treatment of young and elderly patients with trigeminal neuralgia, and compare the clinical effect of the pulsate radiofrequency ganglion in the treatment of the elderly with trigeminal nerve in the elderly, and provide experience for the future clinical treatment. Methods: collect from June 2015 to 2016. In June, the patients were diagnosed with trigeminal neuralgia in Tianjin II. These patients were usually patients with trigeminal neuralgia of primary or conservative treatment. The function of the patients was normal, GCS was not used before the pulse radiofrequency treatment. 20 cases of young trigeminal neuralgia (group A), and 20 cases of senile trigeminal neuralgia (B The two groups of patients were treated with pulse radio frequency therapy (60 seconds, 3 cycles). After informing the related risk, the patients were voluntarily involved in the intervention treatment, and all the patients signed the consent form before the treatment. After entering the operation room, the patients were given the supine position, the shoulder pads a thin pillow high, the head light back, the electrocardiogram monitor, and the upper limb venous access. The target target was the three fork of the affected side. Nerve semilunar ganglion. First use a ruler to measure the length of the zygomatic arch, and mark the middle point by the scale. The scale takes the lateral 2.5cm and 1cm as the needle point. It is equivalent to the lower edge of the temporomandibular arch above the maxillary molar, or the second upper molar is the puncture point. After 0.5% lidocaine subcutaneous local anaesthesia, 7 number 10cm long wear Needle puncture, the direction of the tip of the needle was observed at the middle of the pupil on the front. The direction of the needle point was observed at the middle point of the zygomatic arch from the side, and the needle was slowly entered. The needle tip reached the semilunar ganglion of the oval hole under the guidance of CT, and the local anesthetic test was given, and the patients of.A group (patients with young trigeminal neuralgia) did not take the pulse radiofrequency (60 Second, 3 cycles), B group (elderly trigeminal neuralgia patients) patients with pulse radio frequency (60 seconds, 3 cycles). Pulse radiofrequency treatment to keep the patients in the supine position 3h.A, B two groups of patients in each time of the pain score and sleep quality score, after the detailed clinical evaluation of postoperative patients, calculated the pulse radiofrequency treatment The postoperative complications were recorded and followed up. Results: 1 group A (young patients) in two groups: male and female 13; the course of pain was 1.0~5.0 months, the average course was 2.6 months, the age of the patient was 30~40, the average age was 32 years old and pain model. There were 8 cases of trigeminal nerve, II and III or III.B group (elderly patients): male patients accounted for 8 cases, female patients accounted for 12 cases, the course of pain was 1.0~5.0 months, the average course of disease was 2.65 months, the age range was 60~70 years, the average age was 63 years old, the pain range was trigeminal II Branch, II and III or III branch.2 two patients pulse Before radiofrequency treatment, pain score and sleep quality score in group A (young patients) were 7.10 + 0.79, and sleep quality was 6.15 + 0.59. The pain scores of patients in group B (elderly patients) were 7 + 0.73, and the sleep quality score was 6.20 + 0.62; A and B group before pulse radiofrequency treatment pain score And no significant difference in sleep quality score (P0.05) the pain score and sleep score after pulse radio frequency treatment in group.3 two were 3.1 two groups after pulse radiofrequency therapy in group A (young patients), the pain scores at each time point were 4.10 + 0.64,2.75 + 0.72,2.35 + 0.59,2.10 + 0.64 respectively after pulse radio frequency therapy, each time after pulse radio frequency therapy The pain score was significantly lower than that in group P0.01.B (P0.01) (elderly patients). The pain scores at each time point were 4.25 + 0.77,2.50 + 0.76,3.65 + 0.49 respectively. The VAS scores in each time period after the operation were significantly decreased (P0.01).A, B two groups 1 weeks, 1 months, 3 month VAS scores did not have significant difference (P0.05).A group treatment 6 months after treatment was significantly lower than that of group B (P0.01) after treatment (P0.01). The SIS score in group A after operation in group.3.2 two after operation was 4.20 + 0.62,2.34 + 0.49,2.05 + 0.61 respectively. The sleep quality score of each time period after pulse radio frequency treatment was significantly lower than that before operation (P0.01).B group. It was 4.30 + 0.66,2.45 + 0.59,2.15 + 0.59,2.75 + 0.62. The SIS scores in each time period were significantly lower than that before operation (P0.01).A. The pain scores in the B two groups were 1 weeks, 1 months, 3 months and 6 months were significantly lower than those before the operation (P0.01), and 6 months after the treatment in the A group were significantly lower than those of the B group for 6 months. The efficiency of group patients at different time points after radiofrequency treatment was compared in group A (young patients) after 1 weeks, 1 months, 3 months, 6 months, 91%, 88%, 83%, 74%, and group B (elderly patients) after pulse radio frequency therapy for 1 weeks, 1 months, 3 months, 6 months, respectively, 89%, 86%, 70%.A, B, T1, T2, T3 efficiency was not effective. The significant difference (P0.05) in group.A was significantly higher than that of group B (P0.01) after 6 months of treatment (P0.01) in.5 and postoperative patients with high blood pressure after pulse radiofrequency treatment, after decompression and other symptomatic treatment, real-time monitoring of ECG monitoring, the gradual recovery of blood pressure and no other discomfort symptoms, among which group A (young patients) There were 1 cases, group B (elderly patients) and 2 cases. There were 3 cases of local swelling in the puncture site during the follow-up. The patients were guided by intermittent ice compress, and the swelling was often eliminated quickly after the operation. After the operation, 2 of the patients had nausea, vomiting, nerve stimulation, and the treatment of discomfort improved. 1 patients appeared. The upper eyelid was slightly limited in the upper eyelid, and the upper eyelid weakness was improved in January after treatment. 3 months after treatment, the two groups had no intracranial hematoma, infection, and masticatory muscle weakness. Conclusion: CT guided radiofrequency for the second half of the month was safe and effective for the treatment of young and elderly trigeminal neuralgia. There was no significant difference in the pain of the trigeminal nerve distribution in the patients and the improvement of the sleep quality of the patients within.3 months. But in June, the young patients were better than the elderly patients with trigeminal neuralgia. There was no significant difference between the two groups in the improvement of sleep quality in March, but the young patients in June were better than the elderly three after the treatment. Trigeminal neuralgia can be used as the first choice for young patients with trigeminal neuralgia.

【學(xué)位授予單位】：承德醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R745.11

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