2024 年第 8 期 第 0 卷

原发性三叉神经痛患者经皮穿刺三叉神经半月节球囊压迫术围手术期瞬目反射变化特点及其与患者术后长期疗效的关系

Perioperative characteristics of blink reflex in patients with primary trigeminal neuralgia undergoing percutaneous trigeminal gasserian ganglion balloon compression and its relationship with long-term postoperative efficacy

作者：史皓威郭文昌王银占王永宇杨嗣徽李洋钱涛

英文作者：Shi Haowei Guo Wenchang Wang Yinzhan Wang Yongyu Yang Sihui Li Yang Qian Tao

单位：河北省人民医院神经外一科，石家庄050000

英文单位：First Department of Neurosurgery Hebei General Hospital Shijiazhuang 050000 China

关键词：原发性三叉神经痛；经皮穿刺三叉神经半月节球囊压迫术；瞬目反射；长期疗效

英文关键词：Primarytrigeminalneuralgia;Percutaneoustrigeminalgasserianganglionballooncompression; Blinkreflex;Long-termefficacy

• 摘要：

• 目的 探究原发性三叉神经痛（PTN）患者经皮穿刺三叉神经半月节球囊压迫术（PBC）围手术期瞬目反射变化特点及其与患者术后长期疗效的关系。方法 收集2020年2—10月于河北省人民医院行PBC的150例PTN患者的临床资料进行回顾性分析。所有患者均于术前1 d、术后1 d及术后第1、3、6、12个月分别进行巴罗神经病学研究所疼痛量表评分（BNI-P）、巴罗神经病学研究所面部麻木评分（BNI-N）评估面部麻木、疼痛情况，并进行瞬目反射检测（涉及传导通路R1、R2及R2′的潜伏期及波幅）。根据患者术后第3年随访结果分为治愈组（120例）和复发组（30例）。比较2组患者临床资料，采用Logistic回归方法分析患者远期预后的影响因素并建立预测模型、评价模型拟合优度。结果 患者术后1 d及术后第1、3、6、12个月BNI-P评分均明显低于术前1 d（均P<0.05）。患者行PBC后，R1、R2、R2′潜伏期总体均呈现降低趋势，R1、R2、R2′波幅总体均呈现上升趋势（均P<0.05）。纳入最全面因素的多因素Logistic回归分析结果显示体重指数（比值比=1.254，P=0.028），病程（比值比=1.072，P=0.008），术前BNI-P（比值比=2.189，P=0.040），术前R1、R2、R2′潜伏期（比值比=3.546、4.165、1.314，P=0.012、0.014、0.038）、术前R1、R2、R2′波幅（比值比=0.933、0.920、0.942，P=0.009、0.003、0.002）均为远期预后的影响因素。Hosmer-Lemeshow检验显示模型具有较好的拟合优度（P=0.796）。结论 对PTN患者行PBC治疗可取得较好的临床治疗效果，其瞬目反射各项指标均随术后随访时间呈现降低趋势，且与患者面部麻木症状呈现正相关性，患者个体因素及术前BNI-P、瞬目反射指标水平等均对患者术后长期疗效具有重要影响。

• Objective To investigate the perioperative characteristics of blink reflex in patients with primary trigeminal neuralgia(PTN) undergoing percutaneous trigeminal gasserian ganglion balloon compression(PBC) and its relationship with long-term postoperative efficacy. Methods  The clinical data of 150 PTN patients who underwent PBC in Hebei General Hospital from February to October 2020 were collected and retrospectively analyzed. All patients were evaluated for facial numbness and pain using the Barrow Neurological Institute painseverity(BNI-P) and Barrow Neurological Institute facial numbness(BNI-N) at 1 d before surgery, 1 d after surgery, and 1, 3, 6, and 12 months after surgery, respectively. Blink reflex testing(involving the latency and amplitude of conduction pathways R1, R2, and R2′) was also performed. According to the follow-up results in the third year after surgery, the patients were divided into cure group(120 cases) and recurrence group(30 cases). The clinical data of the two groups were compared, and the Logistic regression method was used to analyze the influencing factors of the long-term prognosis of the patients, establish a prediction model, and evaluate the goodness of fit of the model. Results   The BNI-P scores of patients at 1 d after surgery and at 1, 3, 6, and 12 months after surgery were significantly lower than that at 1 d before surgery(all P<0.05). After PBC treatment, the latency of R1, R2, and R2′ showed an overall decreasing trend, while the amplitude of R1, R2, and R2′ showed an overall increasing trend (all P<0.05). The results of the multivariate Logistic regression analysis incorporating the most comprehensive factors showed that body mass index(odds ratio=1.254, P=0.028), disease duration(odds ratio=1.072, P=0.008), preoperative BNI-P(odds ratio=2.189, P=0.040), preoperative R1, R2, and R2′ latency (odds ratio=3.546, 4.165, 1.314; P=0.012, 0.014, 0.038), and preoperative R1, R2, and R2′ amplitude (odds ratio=0.933, 0.920, 0.942; P=0.009, 0.003, 0.002) were all influencing factors for long-term prognosis. The Hosmer-Lemeshow test showed that the model had good goodness of fit(P=0.796). Conclusions  PBC treatment of PTN patients can achieve good clinical efficacy, and the blink reflex indexes show a decreasing trend with the follow-up time, and there is a positive correlation between the symptoms of facial numbness. Individual factors, preoperative levels of BNI-P and blink reflex have important effects on the long-term efficacy of PTN patients after surgery.