颅外非半月节射频热凝治疗三叉神经痛时危急事件的处理与预防

Treatment and prevention of critical events in radiofrequency thermocoagulation of extracranial non-semilunar ganglion for trigeminal neuralgia

目的总结CT引导下经皮穿刺颅外非半月节射频热凝治疗原发性三叉神经痛时的危急事件处理经验，提出相应的防范措施以确保治疗的安全性。方法调阅CT手术室不良事件登记本，结合相应的临床操作及护理记录，回顾分析2015年1月-2017年9月间浙江省嘉兴市第一医院疼痛科收治的248例原发性三叉神经痛患者在接受“CT引导下经皮穿刺颅外非半月节射频热凝治疗”过程中的各类危急事件处理。结果本组248例经皮穿刺颅外非半月节射频热凝治疗期间，诱发术中高血压126例，其中达危急值（200／100mmHg）者47例，经静注乌拉地尔后得以控制；发生呼吸抑制，脉搏血氧饱和度下降者63例，其中11例脉搏血氧饱和度低于80％，7例经托下颌解除舌后坠并加大吸氧流量后回升至92％以上，另4例需经高压面罩辅助通气后回升至正常；出现射频时心率骤降至50次以下者26例，经静注阿托品后回升至正常；4例出现快房颤，其中3例房颤心率200次/min以上，紧急静注可达龙后转为窦性心率；4例出现恶心呕吐，经解除头部固定约束带并将头偏向健侧，无误吸发生；3例患者挣动时静脉输液套管针蹭落，立即再行静脉穿刺留置套管针。结论尽管颅外非半月节射频热凝治疗时穿刺针无需进入颅内，较传统的颅内半月节射频更安全，但治疗期间仍会有血压骤升、呼吸抑制、心率骤降等危急事件发生，充分的术前准备、术中严密监护、及时发现病情变化并快速处理是三叉神经射频治疗的安全保证。

Objective To evaluate the CT-guided percutaneous extracranial non-semilunar ganglion radiofrequency thermoeoagulation for the treatment of primary trigeminal neuralgia. Methods A retrospective analysis was conducted on 248 cases with primary trigeminal neuralgia who were admitted Jiaxing First Hospital in between January 2015 and September 2017. All patients treated with the CT-guided percutaneous extracranial non-semilunar ganglion radiofrequency thermocoagutation. All the clinical data were observed and recorded with the treatment. Results 126 of 248 cases were induced intraoperative hypertension, of which up to the critical value （200/100 mmHg） in 47 cases during the procedure of percutaneous extracranial non-semilunar ganglion radiofrequeney thermocoagulation. Pulse oxygen saturation （SPO2） decreased in 63 cases, of which 11 cases of SPO2 were less than 80%. The frequency of sudden drop in heart rate was less than 50 bpm in 26 cases. Four cases had fast atrial fibrillation, of which 3 cases of atrial fibrillation heart rate of 200 times per min. 4 cases of nausea and vomiting; In 3 patients, the intravenous infusion cannula rubbed off. All that happened was effectively controlled. Conclusion The radiofrequency thermocoagulation of extracranial non-semilunar ganglion is the effective treatment for trigeminal neuralgia. The critical situations need to be preoperative adequate prepared, intraoperative strict monitored. Timely detection of changes of the vital signs is the safety assurance for the treatment.