三叉-心脏反射在颅底肿瘤患者手术中的临床特征

Clinical analysis of trigemino-cardiac reflex during surgery for patients with skull base tumors

目的探讨颅底肿瘤手术中发生的三叉-心脏反射（TCR）的临床特征、相关因素和预后。方法回顾2009年10月至2011年12月首都医科大学附属北京天坛医院神经外科262例颅底肿瘤患者在全身麻醉下开颅手术中发生的TCR，并分析与TCR相关的肿瘤类型和手术入路以及术后并发症。结果17例患者术中发生TCR（占6．5％）。其中男8例，女9例，平均年龄40．5岁。肿瘤类型以神经鞘瘤最多，共11例（64．7％）；手术入路以枕下乙状窦后入路最多见，其次为中颅底经天幕入路，分别为11例和4例（共占88．2％）。术中停止手术刺激后血压和心率恢复正常。术后过程顺利，术后无TCR相关的心血管系统并发症。结论TCR可发生于颅底肿瘤手术中，尤其是神经鞘瘤切除术和枕下乙状窦后入路以及中颅底经天幕入路；正确识别和处理颅底肿瘤手术中的TCR则预后良好。

Objective To investigate the clinical features, risky factors and outcome of the trigemino-cardiac reflex （TCR） during surgery for skull base tumors. Methods Two hundred and sixty-two neurosurgical patients with skull base tumors underwent general anesthesia and open surgery from October 2009 to December 2011 in department of neurosurgery of Beijing Tiantan Hospital. The occurrence of TCR and the type of tumor, the surgical approach as well as the postoperative complication relative to TCR was evaluated retrospectively. Results Seventeen patients occurred TCR events intraoperatively （6. 5% ）. There were 8 men and 9 women with an average age of 40. 5 years. Eleven of them （64. 7% ） underwent schwannoma surgery. Regarding with the surgical procedure, the suboccipital retrosigmoidal approach and the middle fossa transtentorial approach were most commonly associated with TCR in this series （ 88.2% ）. The heart rate and blood pressure returned to the patient＇s normal baseline level after cessation of the surgical manipulation. There was no TCR-relative complication in cardiovascular system. The postoperative course is uneventful in all 17 patients. Conclusions TCR may occur during surgery for skull base tumor, especially when performing schwannoma surgery and suboccipital retrosigmoidal or middle fossa transtentorial approach. Accurate recognition and management of TCR during skull base surgery often carry on favorable outcome.