瞬目反射对微血管减压术后迟发性面神经麻痹的预测价值

The value of BR in evaluating the occurrence of DFP after MVD for HFS and the mechanism of DFP

目的研究面肌痉挛微血管减压术（MVD）前后瞬目反射的变化，探讨术后迟发性面神经麻痹（DFP）的发生机制。方法对60例面肌痉挛患者术前1d、术后第1、3、5天行瞬目反射检查，并观察DFP的发生。结果56例术后未出现DFP，但瞬目反射检查仍表现为短暂的R1、R2潜伏期延长，且R1潜伏期于术后第5天，R2潜伏期于术后第3天恢复至术前水平。4例分别于术后第6—15天出现DFP症状，术后瞬目反射记录表现为R1潜伏期逐渐延长，甚至波形消失。结论MVD对面神经功能存在影响，对于大部分患者（93％），面神经功能术后5d内可自行恢复，而R1潜伏期逐渐延长甚至波形消失则表现为DFP。瞬目反射检查中R1波的监测对MVD术后DFP的发生有一定的预示作用。

A Objective To observe the change in blink reflex（BR） before and after microvascular decompression（MVD） for hemifacial spasm（HFS） and discuss the possible mechanism of delayed facial palsy （DFP）. Method 60 patients with HFS were examined before and every two days after the surgery and the occurrences of DFP were observed. Results In 56 cases DFP did not appear, but BR examination still revealed the postoperative short - term prolongations in the latencies of RI and R2. The latencies of R1 returned to preoperative levels in 5 days and the latencies of R2 returned to preoperative levels in 3 days after the operations. DFP occurred in 4 cases during 6 - 15 days after MVD, in which the prolongations in the latencies of R1 were gradual and irreversible. Conclusions The functions of Ⅷ were slightly injuryed during MVD. And most of cases（93% ） could recover in 5 days, while the dysfunction of Ⅶ were getting worse in the others in which BR tests showed gradual prolongations in the latencies of R1 or the disappearance of R1 waveform. DFP was finally occurred to these patients. The changes in RI - wave have some important value in evaluating the possibility of the occurrence of DFP after MVD for HFS.