面肌痉挛微血管减压术后迟发性面瘫的影响因素分析

Analysis of influencing factors of delayed facial paralysis after microvascular decompression for hemifacial spasm

目的分析面肌痉挛患者行微血管减压术(MVD)后出现迟发性面瘫的影响因素,以期为降低MVD术后出现迟发性面瘫的风险提供预防措施。方法回顾性分析我院收治的134例面肌痉挛患者的临床资料,根据患者术后是否出现迟发性面瘫将其分成术后面瘫组(29例)和术后无面瘫组(105例)。比较2组患者的临床资料(性别、年龄、饮酒、吸烟、高血压、糖尿病、脑梗死、术前病程、术中Telfon棉用量、责任血管类型),采用单因素和多因素Logistic回归分析影响面肌痉挛患者行MVD术后出现迟发性面瘫的危险因素。结果2组患者性别、年龄、饮酒、吸烟、高血压、糖尿病、脑梗死情况比较,差异均无统计学意义(P>0.05)。2组患者术前病程、术中Telfon棉用量、责任血管类型比较差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,患者术前病程>5年、Telfon棉用量>3片和责任血管为面神经供血动脉是面肌痉挛患者行MVD术后出现迟发性面瘫的危险因素(P<0.05)。结论患者术前病程越长、术中Telfon棉用量越多、责任血管为面神经供血动脉(小脑前下动脉),MVD后出现迟发性面瘫的可能性越大。MVD中应尽量轻柔操作,保护面神经及其供血动脉,术后应及时应用改善血管循环药物缓解血管痉挛。

Objective To analyze the influencing factors of delayed facial paralysis in patients with hemifacial spasm after microvascular decompression(MVD),so as to provide preventive measures to reduce the risk of delayed facial paralysis after MVD.Methods The clinical data of 134 patients with hemifacial spasm admitted to our hospital were retrospectively analyzed,and the patients were divided into the postoperative facial paralysis group(29 cases)and the postoperative non-facial paralysis group(105 cases)according to whether they had delayed facial paralysis after operation.The clinical data of the two groups of patients(gender,age,alcohol consumption,smoking,hypertension,diabetes,cerebral infarction,preoperative course of disease,intraoperative dosage of Telfon cotton,type of responsible blood vessel)were compared.The univariate and multivariate Logistic regression analysis were used to analyze the risk factors of delayed facial paralysis after MVD in patients with hemifacial spasm.Results There was no statistically significant difference in gender,age,alcohol consumption,smoking,hypertension,diabetes,and cerebral infarction between the two groups(P>0.05).There were statistically significant differences in the preoperative course of disease,the intraoperative dosage of Telfon cotton and the type of responsible blood vessel between the two groups(P<0.05).The multivariate Logistic regression analysis showed that the patient’s preoperative course of disease>five years,the intraoperative dosage of Telfon cotton>three tablets and the facial nerve supply artery as the responsible blood vessel were the risk factors of delayed facial paralysis after MVD in patients with hemifacial spasm(P<0.05).Conclusion Longer preoperative course,more Telfon cotton used during the operation,and the responsible blood vessel which was the artery supplying blood to the facial nerve(anterior inferior cerebellar artery)increase the possibility of delayed facial paralysis after MVD.The MVD should be operated as gently as possible to protect the facial nerve and its blood supply artery.After the operation,drugs should be used to relieve vasospasm to improve vascular circulation in time.