【摘要】：目的:面肌痙攣常表現(xiàn)為單側(cè)面部肌肉不自主抽搐,目前首選的外科治療手段為乙狀竇后入路微血管減壓術(shù)。但小腦橋腦角區(qū)解剖結(jié)構(gòu)復雜,責任血管常與面神經(jīng)糾結(jié)伴行,游離時易因牽拉而對其造成刺激甚至損傷,導致術(shù)后相關(guān)并發(fā)癥的產(chǎn)生,如頭痛、頭暈、聽力下降、面癱等。尼莫地平作為鈣離子通道阻滯劑,具有緩解血管痙攣及改善腦循環(huán)的作用。本文觀察圍手術(shù)期應(yīng)用尼莫地平與否對預防和緩解原發(fā)性面肌痙攣患者微血管減壓術(shù)后并發(fā)癥的療效,并對數(shù)據(jù)進行統(tǒng)計學分析。方法:對我院2014年1月至2016年10月共90例面肌痙攣患者,隨機分為2組,治療組與對照組各45例,均行微血管減壓手術(shù)治療。兩組患者一般情況無明顯差異,均為單側(cè)發(fā)病,行MRI檢查明確診斷并排除占位性病變。術(shù)前聽力正常,無頭暈、頭痛、面癱等癥狀。兩組患者術(shù)后均給予相同治療方案,其中治療組患者在圍手術(shù)期加用尼莫地平,術(shù)前1日起靜脈泵入尼莫地平注射液0.8mg/h,連用5日,后改為口服尼莫地平片2周60mg Q4h。術(shù)后隨訪至少6個月。結(jié)果:82例患者術(shù)后面肌痙攣癥狀即刻消失,術(shù)后即刻有效率91.1%,其余患者術(shù)后癥狀均明顯改善。其中5例患者術(shù)后7日內(nèi)癥狀消失,其余3例患者在隨訪1-3個月中癥狀均消失�？傮w有效率100.0%。其中治療組患者術(shù)后發(fā)熱11例,頭痛12例,頭暈7例,遲發(fā)性面癱2例,聽力下降4例,腦脊液漏1例;對照組患者發(fā)熱12例,頭痛14例,頭暈15例,遲發(fā)性面癱8例,聽力下降11例,腦脊液漏1例。全部患者均未出現(xiàn)顱內(nèi)感染、腦干梗死等并發(fā)癥。除對照組1例遺留輕度耳鳴外,至隨訪末期其余患者并發(fā)癥均已恢復,其中治療組并發(fā)癥程度及恢復時間均明顯優(yōu)于對照組。結(jié)論:1、微血管減壓術(shù)治療原發(fā)性面肌痙攣效果滿意,安全性高;2、圍手術(shù)期應(yīng)用尼莫地平可減少術(shù)后頭暈、聽力下降、遲發(fā)性面癱等并發(fā)癥的發(fā)生率,并縮短其恢復時間;3、圍手術(shù)期應(yīng)用尼莫地平對術(shù)后發(fā)熱、頭痛、腦脊液漏等并發(fā)癥無明顯療效。
[Abstract]:Objective: hemifacial spasm is often characterized by unilateral facial muscle involuntary convulsion. The preferred surgical treatment is retrosigmoid sinus microvascular decompression. However, the anatomical structure of cerebellopontine angle area is complex, the responsible blood vessels are often accompanied by facial nerve entanglement, and it is easy to cause stimulation and even injury due to traction when dissociating, resulting in the occurrence of postoperative complications, such as headache, dizziness, hearing loss, facial paralysis and so on. As a calcium channel blocker, nimodipine can relieve vasospasm and improve cerebral circulation. The effect of nimodipine on preventing and relieving complications after microvascular decompression in patients with primary hemifacial spasm was observed. Methods: from January 2014 to October 2016, 90 patients with hemifacial spasm in our hospital were randomly divided into two groups: treatment group (n = 45) and control group (n = 45). There was no significant difference between the two groups in general, both of them were unilateral. MRI was performed to diagnose and exclude the space occupying lesions. Preoperative hearing normal, no dizziness, headache, facial paralysis and other symptoms. The patients in the treatment group were treated with nimodipine plus nimodipine during the perioperative period. The patients in the treatment group were injected with nimodipine injection 0.8mg / h 1 day before operation for 5 days, and then treated with nimodipine tablets for 2 weeks 60mg Q4 h. All patients were followed up for at least 6 months. Results: the symptoms of hemifacial spasm disappeared immediately and the effective rate was 91.1%. The symptoms of 5 patients disappeared within 7 days after operation, and the other 3 patients disappeared during 1-3 months follow-up. The overall effective rate is 100.0. In the treatment group, there were 11 cases of fever, 12 cases of headache, 7 cases of dizziness, 2 cases of delayed facial paralysis, 4 cases of hearing loss and 1 case of cerebrospinal fluid leakage. In the control group, there were 12 cases of fever, 14 cases of headache, 15 cases of dizziness, 8 cases of delayed facial paralysis, 11 cases of hearing loss and 1 case of cerebrospinal fluid leakage. All the patients had no complications such as intracranial infection, brainstem infarction and so on. The complications of the treatment group were significantly better than that of the control group except for one case of mild tinnitus left in the control group by the end of follow-up. Conclusion: 1. Microvascular decompression is effective and safe in the treatment of primary hemifacial spasm. 2Perioperative application of nimodipine can reduce the incidence of complications such as dizziness, hearing loss and delayed facial paralysis, and shorten the recovery time. 3. There was no obvious effect of nimodipine on postoperative fever, headache, cerebrospinal fluid leakage and other complications.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R651.3

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