PDF(Pubmed)
Abstract：
OBJECTIVE: The trigeminocardiac reflex (TCR) has traditionally been characterized by a sudden decrease in heart rate, asystole, or hypotension during the manipulation of the trigeminal nerve (MTN) or its branches. While this classical TCR is well-documented, there is limited literature on alternative forms of TCR, such as the development of intraoperative hypertension (HTN) or tachycardia, and the underlying pathogenesis. Furthermore, a gap exists in understanding the correlation between intraoperative blood pressure readings and postoperative outcomes, particularly regarding pain relief in patients with trigeminal neuralgia (TN). Our study aims to examine intraoperative blood pressure trends during microvascular decompression (MVD) for TN and assess their impact on postoperative outcomes.
METHODS: We selected 90 patients who underwent MVD for TN treatment. Blood pressure and heart rate were recorded both preoperatively and during the procedure, specifically during the MTN period, using an arterial line. The Barrow Neurological Institute (BNI) Pain Scale was calculated for all patients both pre- and post-operatively to evaluate pain relief after surgery.
RESULTS: The mean age of the patients was 61.0 ± 12.35 years, with 64.4% being females. Classical TCR (hypotension) was observed in only 2.2% of patients, whereas 80% of patients developed hypertension (≥ 140/90) during MTN. The mean preoperative systolic blood pressure was 128 ± 22.25, and the mean intraoperative systolic blood pressure during MTN was 153.1 ± 20.2. An analysis of covariance, utilizing either preoperative BNI or duration of symptoms as covariate variables, revealed a statistically significant association between intraoperative HTN and postoperative BNI. A linear regression model demonstrated that intraoperative HTN following MTN significantly predicted a lower postoperative BNI score (p = 0.006).
CONCLUSIONS: Intraoperative HTN during MTN, an observed yet underexplored phenomenon, demonstrated a correlation with improved postoperative outcomes. Furthermore, it is recommended to conduct additional investigations into potential neurovascular conflicts in patients not manifesting intraoperative HTN following MTN. A comprehensive understanding of TCR, encompassing its various forms, is vital for optimizing surgical management. This study underscores the imperative for further research to unravel the mechanisms linking intraoperative HTN to surgical outcomes in TN patients.
METHODS: We selected 90 patients who underwent MVD for TN treatment. Blood pressure and heart rate were recorded both preoperatively and during the procedure, specifically during the MTN period, using an arterial line. The Barrow Neurological Institute (BNI) Pain Scale was calculated for all patients both pre- and post-operatively to evaluate pain relief after surgery.
RESULTS: The mean age of the patients was 61.0 ± 12.35 years, with 64.4% being females. Classical TCR (hypotension) was observed in only 2.2% of patients, whereas 80% of patients developed hypertension (≥ 140/90) during MTN. The mean preoperative systolic blood pressure was 128 ± 22.25, and the mean intraoperative systolic blood pressure during MTN was 153.1 ± 20.2. An analysis of covariance, utilizing either preoperative BNI or duration of symptoms as covariate variables, revealed a statistically significant association between intraoperative HTN and postoperative BNI. A linear regression model demonstrated that intraoperative HTN following MTN significantly predicted a lower postoperative BNI score (p = 0.006).
CONCLUSIONS: Intraoperative HTN during MTN, an observed yet underexplored phenomenon, demonstrated a correlation with improved postoperative outcomes. Furthermore, it is recommended to conduct additional investigations into potential neurovascular conflicts in patients not manifesting intraoperative HTN following MTN. A comprehensive understanding of TCR, encompassing its various forms, is vital for optimizing surgical management. This study underscores the imperative for further research to unravel the mechanisms linking intraoperative HTN to surgical outcomes in TN patients.
摘要：
目的：传统上三叉神经心反射（TCR）的特征是心率突然下降，心搏停止,或在操作三叉神经（MTN）或其分支期间低血压。虽然这种经典的TCR是有据可查的，关于TCR替代形式的文献有限，如术中高血压（HTN）或心动过速的发展，以及潜在的发病机制。此外，在理解术中血压读数和术后结果之间的相关性方面存在差距，特别是关于缓解三叉神经痛（TN）患者的疼痛。我们的研究旨在检查TN微血管减压术（MVD）期间的术中血压趋势，并评估其对术后结局的影响。
方法：我们选择了90例接受MVD的患者进行TN治疗。术前和手术过程中记录血压和心率，特别是在MTN期间，使用动脉管线。对所有患者进行术前和术后的BarrowNeurologicalInstitute（BNI）疼痛量表的计算，以评估手术后的疼痛缓解情况。
结果：患者的平均年龄为61.0±12.35岁，64.4%是女性。经典TCR（低血压）仅在2.2％的患者中观察到，而80%的患者在MTN期间出现高血压(≥140/90)。术前平均收缩压为128±22.25,MTN术中平均收缩压为153.1±20.2。协方差分析，利用术前BNI或症状持续时间作为协变量，显示术中HTN和术后BNI之间存在统计学上的显着关联。线性回归模型表明，MTN后的术中HTN显着预测术后BNI评分较低（p=0.006）。
结论：MTN期间的术中HTN，一个观察到的但未充分开发的现象，显示与术后结局改善相关。此外，对于MTN术后未出现术中HTN的患者,建议对其潜在的神经血管冲突进行额外的调查.全面了解TCR,涵盖其各种形式，对于优化手术管理至关重要。这项研究强调了进一步研究的必要性，以阐明术中HTN与TN患者手术结果之间的联系机制。
方法：我们选择了90例接受MVD的患者进行TN治疗。术前和手术过程中记录血压和心率，特别是在MTN期间，使用动脉管线。对所有患者进行术前和术后的BarrowNeurologicalInstitute（BNI）疼痛量表的计算，以评估手术后的疼痛缓解情况。
结果：患者的平均年龄为61.0±12.35岁，64.4%是女性。经典TCR（低血压）仅在2.2％的患者中观察到，而80%的患者在MTN期间出现高血压(≥140/90)。术前平均收缩压为128±22.25,MTN术中平均收缩压为153.1±20.2。协方差分析，利用术前BNI或症状持续时间作为协变量，显示术中HTN和术后BNI之间存在统计学上的显着关联。线性回归模型表明，MTN后的术中HTN显着预测术后BNI评分较低（p=0.006）。
结论：MTN期间的术中HTN，一个观察到的但未充分开发的现象，显示与术后结局改善相关。此外，对于MTN术后未出现术中HTN的患者,建议对其潜在的神经血管冲突进行额外的调查.全面了解TCR,涵盖其各种形式，对于优化手术管理至关重要。这项研究强调了进一步研究的必要性，以阐明术中HTN与TN患者手术结果之间的联系机制。
