Abstract：
Trigeminocardiac reflex (TCR) can result in bradycardia and even cardiac arrest, and is reversible with elimination of the stimulus. Here, we report the case of a 68-year-old man who experienced cardiac arrest during percutaneous balloon compression for the treatment of trigeminal neuralgia. In this patient, sinus rhythm did not recover after stimulation removal, causing us to successfully perform cardiopulmonary resuscitation (CPR). The patient regained a sinus rhythm and was pretreated with atropine 0.5 mg, allowing the operation to be started again. The operation was completed successfully and the patient experienced no complications. Subsequent heart rate variability (HRV) analysis showed that parasympathetic activity predominated before anesthesia induction and after tracheal intubation. It further elevated during foramen ovale puncture, leading to prolonged asystole. Fortunately, sympathetic activity predominated after atropine was administered, which manifested as an increase in sympathetic activity and a decrease in parasympathetic activity. This could be beneficial for patients with TCR. This case indicates that TCR-related cardiac arrest might not be reversed with stimulus cessation, and atropine played a key role in preventing TCR. Moreover, HRV analysis might be essential for preoperative screening for high-risk patients. We also reviewed the literature for cases of TCR with prolonged asystole.
摘要：
三叉神经心反射（TCR）可导致心动过缓甚至心脏骤停，并且随着刺激的消除而可逆。这里,我们报道了一例68岁的男性患者,该患者在经皮球囊压迫治疗三叉神经痛期间出现心脏骤停.在这个病人身上,去除刺激后窦性心律没有恢复，导致我们成功进行心肺复苏（CPR）。患者恢复了窦性心律，并接受了阿托品0.5mg的预处理，允许再次启动操作。手术顺利完成，患者无并发症。随后的心率变异性（HRV）分析表明，在麻醉诱导前和气管插管后，副交感神经活动占主导地位。在卵圆孔穿刺过程中进一步升高，导致长时间的心搏停止。幸运的是,在服用阿托品后，交感神经活动占主导地位，表现为交感神经活动的增加和副交感神经活动的减少。这对于TCR患者可能是有益的。这种情况表明TCR相关的心脏骤停可能不会随着刺激停止而逆转，阿托品在预防TCR方面发挥了关键作用。此外，HRV分析可能对于高危患者的术前筛查至关重要。我们还回顾了有关TCR伴长期心搏停止的文献。
