本文選題：三叉神經(jīng)痛 + 腦干三叉神經(jīng)誘發(fā)電位��； 參考：《蘭州大學(xué)》2017年碩士論文

【摘要】：目的建立及優(yōu)化腦干三叉神經(jīng)誘發(fā)電位(brain stem trigeminal evoked potentials,BTEP)的臨床檢測方法及BTEP的正常參考值,并以此為基礎(chǔ)評價原發(fā)性三叉神經(jīng)痛病人的BTEP變化及其與顯微血管減壓術(shù)療效及并發(fā)癥的相關(guān)性。方法以蘭大二院2015年12月至2017年3月期間行BTEP監(jiān)測的80例患者為研究對象,包括原發(fā)性三叉神經(jīng)痛(Primary Trigeminal Neuralgia,PTN)25例、面肌痙攣(hemifacial spasm,HFS)50例、舌咽yL經(jīng)痛(glossopharyngeal neuralgia,GPN)5例。首先將51例HFS和4例GPN患者隨機分為導(dǎo)航組(30例)和徒手組(25例),分別刺激眶上神經(jīng)、眶下神經(jīng)和頦神經(jīng),檢測并對比兩種穿刺方法BTEP的出圖率。同時測量BTEP W1、W2、W3的潛伏期及W2、W3的波幅,建立正常參考值。隨后分別對25例實施顯微血管減壓術(shù)的PTN患者,記錄其術(shù)前、術(shù)后患側(cè)和健側(cè)的BTEP指標(biāo)并予以對比,結(jié)合臨床進行綜合評價。結(jié)果導(dǎo)航組和徒手組在眶上神經(jīng)BTEP的引出率均較低(50%vs 18%),但導(dǎo)航組引出率明顯較高(χ2=12.20,P0.05),眶下神經(jīng)BTEP的引出率高且穩(wěn)定(96.7%vs 88%),且應(yīng)用導(dǎo)航后引出率有增高趨勢,但無統(tǒng)計學(xué)顯著性(χ2=3.04,P0.05),刺激頦神經(jīng)后BTEP的引出率更低(16.7%vs 8%),即使應(yīng)用導(dǎo)航后也未見提高(χ2=1.84,P0.05)。對25例PTN的研究結(jié)果顯示三叉神經(jīng)痛患者術(shù)前BTEP的W2、W3表現(xiàn)為潛伏期延長和(或)波形消失,與健側(cè)BTEP比較有顯著差異(P0.05),BTEP的變化與術(shù)后患者癥狀一致,術(shù)后23例病人三叉神經(jīng)傳導(dǎo)功能恢復(fù),術(shù)后疼痛癥狀消失,無面部麻木,2例病人術(shù)后W2、W3波形未恢復(fù),術(shù)后雖然面部疼痛癥狀消失,但出現(xiàn)面部麻木。結(jié)論刺激眶下神經(jīng),刺激強度在1mA~5 mA時,出圖率高,且波形穩(wěn)定。BTEP正常參考值的的建立,可進行原發(fā)性三叉神經(jīng)痛的診斷;MVD后BTEP的W2、W3波的顯著改善,支持血管壓迫引起三叉神經(jīng)痛的學(xué)說;BTEP有助于判斷三叉神經(jīng)傳導(dǎo)功能有無異常,可用于指導(dǎo)手術(shù)避免神經(jīng)損傷,評估減壓是否充分,同時可對預(yù)后作出評價。
[Abstract]:Objective to establish and optimize the clinical detection method of brain stem trigeminal evoked potentialsof brainstem trigeminal evoked potential (BTEP) and the normal reference value of BTEP. To evaluate the changes of BTEP in patients with primary trigeminal neuralgia and its correlation with the efficacy and complications of microvascular decompression. Methods from December 2015 to March 2017, 80 patients underwent BTEP monitoring in the second Orchid University Hospital, including 25 patients with primary Trigeminal Neuralgiahe, 50 patients with hemifacial spasmosis, and 5 patients with glossopharyngeal yl glossopharyngeal neuralgia GPNs, including 25 patients with primary trigeminal neuralgia, 50 patients with hemifacial spasmosis and 5 patients with glossopharyngeal glossary neuralgia GPNs. First, 51 patients with HFS and 4 patients with GPN were randomly divided into navigation group (n = 30) and unarmed group (n = 25). The supraorbital nerve, suborbital nerve and mental nerve were stimulated, respectively. The imaging rate of BTEP was detected and compared. At the same time, the incubation period and amplitude of BTEP W1, W2 and W3 were measured, and the normal reference values were established. Subsequently, 25 cases of PTN patients undergoing microvascular decompression were recorded and compared with the BTEP indexes of the affected and healthy sides before and after the operation, and the comprehensive evaluation was carried out in combination with clinical practice. Results the extraction rate of BTEP in the supraorbital nerve in navigation group and barehanded group was lower than that in the control group (50 vs 18), but the extraction rate of BTEP in navigation group was significantly higher (蠂 ~ 2 / 12.20 / P0.05, P < 0.05). The extraction rate of BTEP in suborbital nerve was higher than that in control group (P < 0.05). The extraction rate of BTEP in suborbital nerve was higher than that in navigation group (P < 0.05). However, there was no statistical significance (蠂 ~ 2 / 3.04 / P _ (0.05). The extraction rate of BTEP after stimulation of mental nerve was lower than that after stimulation of mental nerve (蠂 ~ (2), and it was not improved even after the application of navigation (蠂 ~ (2) 1.84) (P ~ (0.05). The results of 25 cases of PTN showed that the W2T W3 of BTEP in patients with trigeminal neuralgia before operation was prolonged latency and / or waveform disappeared, there was significant difference compared with normal side BTEP. The trigeminal nerve conduction function was recovered in 23 patients after operation, and the symptoms of pain disappeared after operation, and the W2W3 waveform did not recover in 2 patients without facial numbness. Although the symptoms of facial pain disappeared after operation, the symptoms of facial numbness appeared. Conclusion when the stimulation intensity of the suborbital nerve is at 1mA~5 Ma, the imaging rate is high, and the normal reference value of the waveform is stable. The establishment of the normal reference value can improve the W2W3 wave of BTEP after the diagnosis of primary trigeminal neuralgia. Supporting the theory of trigeminal neuralgia caused by vascular compression BTEP is helpful to judge whether the trigeminal nerve conduction function is abnormal, to guide the operation to avoid nerve injury, to evaluate the adequacy of decompression, and to evaluate the prognosis.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R651.3

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