低浓度大容量利多卡因混合镇痛液用于颈源性头痛神经阻滞的临床观察

目的观察低浓度大容量与常规浓度剂量的利多卡因混合镇痛液在颈源性头痛神经阻滞治疗上的临床疗效和安全性。方法选用符合颈源性头痛诊断标准的108例患者,分为2组各54例。治疗组以0．1％利多卡因60～80mL加得宝松0．5rnL、甲钴胺1mg。对照组以0．5％利多卡因40mL加得宝松0．5mL、甲钴胺1mg分别行枕神经、Q横突、颈部竖棘痛点阻滞,注射镇痛液3～5mL。每周1次,4次为一个疗程。评价2组临床疗效、疼痛视觉模拟评分（vAs评分）、不良反应。结果2组临床疗效无显著差异。与治疗前比较,2组治疗后1周、治疗后1个月、治疗后3个月、治疗后6个月时的头痛VAS评分均明显低于治疗前。治疗组治疗后各时间点VAS评分均明显低于对照组。治疗组不良反应总发生率明显低于对照组。结论低浓度大容量利多卡因用于颈源性头痛的神经阻滞是一种不良反应少,疗效确切的方法,尤其适用于老年患者的治疗。     

三叉神经周围支撕脱术治疗三叉神经痛疗效观察

目的探讨三叉神经周围支撕脱术治疗三叉神经痛的近期疗效。方法对23例确诊为原发性三叉神经痛者,施行神经撕脱术。第一支1例,第二支11例,第三支11例。结果本组23例,22例有效,1例无效。8例在术后10d有一过性跳疼。术后半年至8年复发的6例中,第二支2例,第三支4例,其中3例又再次手术。结论三叉神经痛周围支撕脱术治疗三叉神经痛近期疗效好,远期疗效还待进一步观察。     

普瑞巴林联合神经阻滞治疗老年带状疱疹后三叉神经痛的疗效

目的观察普瑞巴林联合神经阻滞治疗老年带状疱疹后三叉神经痛的效果。方法 45例带状疱疹后三叉神经痛患者随机分为观察组和对照组,对照组采用口服普瑞巴林胶囊,观察组在对照组的基础上加用神经阻滞法。治疗4周后采用视觉模拟评分(VAS)和睡眠质量评分(PSQI)评价临床疗效。结果 2组患者治疗前及治疗1周后VAS评分和PSQI评分均无显著差异(P0.05),但治疗第2、3、4周,2组患者VAS评分和PSQI评分均显著降低,且观察组较对照组降低更为显著,差异有统计学意义(P0.05)。结论普瑞巴林联合神经阻滞治疗老年带状疱疹后三叉神经痛效果好,操作简单,值得临床应用。     

神经阻滞联合干扰素α治疗原发性三叉神经痛临床疗效观察

目的:研究神经阻滞联合干扰素α(interferon alpha, IFN-α)治疗三叉神经痛与常规神经阻滞药物相比较的临床疗效有无提高。方法:选取原发性三叉神经痛病人40例,按随机数字表法分为实验组与对照组各20例,连续行间隔时间为5天的3次神经阻滞治疗,随访6个月,采用视觉模拟评分法(visual analogue scale, VAS)评价病人治疗前后疼痛变化情况,采用匹兹堡睡眠质量指数(pittsburgh sleep quality index, PSQI)评价病人治疗前后睡眠情况变化,比较两组病人总体疗效和疼痛复发情况。结果:随访6个月后,两组病人VAS评分结果显示,实验组有效率为90%,对照组为75%,两组治疗的有效率之间有显著性差异(P <0.05)。两组病人PSQI评分之间存在显著性差异(P <0.05),实验组评分低于对照组。治疗过程中均未出现不良反应。结论:使用IFN-α联合神经阻滞治疗三叉神经痛较常规神经阻滞疗效较好,安全无明显不良反应,可在治疗时考虑使用。     

干扰素α用于椎旁神经阻滞治疗带状疱疹后神经痛的临床疗效

目的:探讨重组人干扰素α(interferon alpha, IFN-α)用于椎旁神经阻滞治疗带状疱疹后神经痛(postherpetic neuralgia, PHN)的临床疗效。方法:选取PHN病人80例,分为实验组(A组)和对照组(B组)。A组在椎旁神经阻滞药物配方中加用IFN-α,B组除在椎旁神经阻滞药物配方中未加用IFN-α外,其余治疗与A组相同。于治疗前及治疗后1、2、3月进行视觉模拟评分法(visual analogue scale, VAS)评分、匹兹堡睡眠质量指数(pittsburgh sleep quality index, PSQI)评分,并统计椎旁神经阻滞治疗次数。结果:A组病人治疗后1、2、3月VAS评分及PSQI评分均低于B组(P <0.05),治疗次数少于B组(P <0.05);A组病人的总有效率高于B组(P <0.05)。结论:IFN-α用于椎旁神经阻滞治疗PHN病人的临床疗效确切,可以减轻病人的疼痛,提高病人的睡眠质量。     

重复经颅磁刺激联合加巴喷丁治疗原发性三叉神经痛的疗效及安全性评估

目的：探讨重复经颅磁刺激（rTMS）联合加巴喷丁对于原发性三叉神经痛（PTN)的治疗效果及安全性。方法：将165例PTN患者随机分为加巴喷丁组（A组）、rTMS组（B组）、rTMS联合加巴喷丁组（C组）各55例，A组患者给与加巴喷丁胶囊口服治疗，B组患者给与rTMS治疗，C组患者给与rTMS联合加巴喷丁治疗。治疗前后对患者进行视觉模拟评分（VAS）、匹兹堡睡眠质量指数量表（PSQI）评定，并记录疼痛缓解率和加巴喷丁使用剂量以及不良反应发生情况。结果：3组患者组内比较，治疗2周后、4周后及治疗后1、3、6个月的VAS评分均呈下降趋势（均P＜0.05）；与A组同时间点比较，B、C组治疗4周后及治疗后随访1、3及6个月的VAS评分均显著降低（均P＜0.05），且C组VAS评分降低更显著（P＜0.05）。3组患者疼痛缓解情况比较均有统计学意义（均P＜0.05），C组疼痛缓解率均显著高于A、B组（均P＜0.05），且C组加巴喷丁使用剂量显著低于A组（P＜0.05）。 B组各项不良反应发生率均低于A、C组（均P＜0.05），C组不良反应总计发生率低于A组（P＜0.05）。治疗后，3组PSQI评分均显著低于治疗前（均P＜0.05），且B、C组PSQI评分均显著低于A组（均P＜0.05），C组PSQI评分显著低于B组（P＜0.05）。结论：联合应用rTMS联合加巴喷丁能够提高原发性三叉神经痛的治疗效果，减少加巴喷丁的使用剂量，改善患者睡眠，同时减少不良反应的发生率，值得临床推广应用。     

Abnormal trigeminal nerve microstructure and brain white matter in idiopathic trigeminal neuralgia

Idiopathic trigeminal neuralgia (TN) is classically associated with neurovascular compression (NVC) of the trigeminal nerve at the root entry zone (REZ), but NVC-induced structural alterations are not always apparent on conventional imaging. Previous studies report lower fractional anisotropy (FA) in the affected trigeminal nerves of TN patients using diffusion tensor imaging (DTI). However, it is not known if TN patients have trigeminal nerve abnormalities of mean, radial, or axial diffusivity (MD, RD, AD – metrics linked to neuroinflammation and edema) or brain white matter (WM) abnormalities. DTI scans in 18 right-sided TN patients and 18 healthy controls were retrospectively analyzed to extract FA, RD, AD, and MD from the trigeminal nerve REZ, and Tract-Based Spatial Statistics (TBSS) was used to assess brain WM. In patients, the affected trigeminal nerve had lower FA, and higher RD, AD, and MD was found bilaterally compared to controls. Group TBSS (P < 0.05, corrected) showed patients had lower FA and increased RD, MD, and AD in brain WM connecting areas involved in the sensory and cognitive-affective dimensions of pain, attention, and motor functions, including the corpus callosum, cingulum, posterior corona radiata, and superior longitudinal fasciculus. These data indicate that TN patients have abnormal tissue microstructure in their affected trigeminal nerves, and as a possible consequence, WM microstructural alterations in the brain. These findings suggest that trigeminal nerve structural abnormalities occur in TN, even if not apparent on gross imaging. Furthermore, MD and RD findings suggest that neuroinflammation and edema may contribute to TN pathophysiology.     

Prevalence of hypertension in patients with trigeminal neuralgia

It is unclear whether hypertension (HTN) is a predisposing factor for the development of trigeminal neuralgia (TN). The purpose of this study was to determine the prevalence of HTN in TN patients and controls at the USC Orofacial Pain and Oral Medicine Center. A retrospective chart review was conducted from a database of over 3,000 patient records from 2003 to 2007. We identified patients diagnosed with TN with or without HTN. A total of 84 patients (54 females; 30 males) between the ages of 33 and 93 years were diagnosed with TN; 37% had TN with HTN and 32% of controls had HTN. The increased prevalence of HTN in the TN patients was not statistically significant (P = 0.50). Since, both TN and HTN are seen in the elderly, it is likely that HTN is simply a co-existing condition in patients with TN and not a risk factor for its development.     

DZY-C型三叉神经立体定向仪治疗三叉神经痛的特点

背景经皮三叉神经半月穿刺损毁术是治疗原发性三叉神经痛的方法之一.因其穿刺技术操作上的难度,可导致误伤及一些严重的并发症.DZY-C型三叉神经立体定向仪治疗原发性三叉神经痛具有穿刺准确度高、并发症低等特点,可减少误伤周围血管、神经的机会.目的评价应用DZY-C型三叉神经立体定向仪治疗三叉神经痛的疗效.设计以患者为研究对象,前后对照研究.单位一所市级中医院的脑外科和一所市级医院.对象2001/2003佛山市中医院门诊或住院部就诊的原发性三叉神经痛患者90例,男39例,女51例;年龄21～90岁.干预所有患者按要求在DZY-C型三叉神经立体定向仪的引导下,经皮穿刺三叉神经半月节,注射甘油.疗效根据视觉模拟评分法(visual ana1ogue scale,VAS)在患者治疗前及治疗后30 min对疼痛程度进行评估.主要观察指标疗效评定结果.结果应用DZY-C型三叉神经立体定向仪,对90例原发性三叉神经痛患者进行三叉神经半月节穿刺,均一次穿刺成功,注射甘油后,原三叉神经疼痛消除90例,优良率达100%.结论DZY-C型三叉神经立体定向仪的结构设计合理,手术操作简易,调节灵活,组织损伤少,使用安全,可明显消除三叉神经痛.     

Urgent care peripheral nerve blocks for refractory trigeminal neuralgia

Objective

After medication failure, patients with refractory trigeminal neuralgia (TGN) often present urgently and seek more potent or invasive therapies such as opioids or surgical options. Peripheral nerve blocks, safe and simple, may offer extended pain relief prior to opioid use or more invasive ganglion level procedures.

Sumatriptan alleviates pain in patients with trigeminal neuralgia

OBJECTIVES: Arterial compression of the trigeminal root may lead to trigeminal neuralgia. 5-HT1B/1D receptor agonists may inhibit vasodilation and inflammation near the irritated trigeminal root. A recent study showed attenuation of mechanical allodynia by a 5-HT1A receptor agonist in a rat model of trigeminal neuralgia. The present study examined the effectiveness of a 5-HT1A/1B/1D receptor agonist, sumatriptan, on pain relief in patients with trigeminal neuralgia. METHODS: The study was conducted in 15 patients with idiopathic trigeminal neuralgia. The patients had been suffering from painful paroxysms for at least 1 month. Each patient was injected with 1 mL of saline subcutaneously (placebo), followed 15 minutes later with subcutaneous sumatriptan (3 mg in 1 mL saline). This was followed the next day by oral sumatriptan (50 mg twice daily) for 1 week. RESULTS: The visual analog scale did not change after saline, but significantly decreased after subcutaneous sumatriptan. Both 1 week after oral sumatriptan and 1 week after discontinuation of the drug, visual analog scale scores resulted in a significant decrease from the baseline. Adverse events after subcutaneous sumatriptan occurred in 4 patients: fatigue in 4 and nausea in 2. Side effects from the oral medication appeared in 4 patients: fatigue in 2, nausea in 1 and chest discomfort in 1. These side effects subsided soon after discontinuation of sumatriptan. CONCLUSIONS: Our results indicate that subcutaneous injection followed by oral administration of sumatriptan produces prompt and continuous analgesia in patients with trigeminal neuralgia.     

三叉神经痛患者的抑郁焦虑情绪调查评估

摘要 目的：观察原发性三叉神经痛患者的抑郁焦虑情况,评估这类患者伴发抑郁焦虑异常症状的危险因素。 方法：原发性三叉神经痛患者176例,年龄15—80岁（男性66例,女性110例）。对患者的一般特点、疼痛评分和抑郁焦虑情绪状态进行采集。根据不同性别、年龄、病程、职业、教育程度、收入和疼痛评分特点分组进行单因素分析,并进行患者间的抑郁焦虑情绪异常的比较和多元回归分析。应用视觉模拟量表（VAS）,贝克抑郁量表和焦虑量表（BDI、BAI）进行评测。 结果：26.7%原发三叉神经痛患者的抑郁阳性（47例）,12例焦虑阳性（6.8%）;女性、短病程、年龄小、职业不稳定、收入低和疼痛评分作为单因素影响患者的抑郁情绪发生,除职业因素外,其余均为三叉神经痛患者伴发抑郁异常的危险因素;焦虑情绪异常发生的单因素结果提示：长病程患者的焦虑异常高发。 结论：三叉神经痛患者伴随高发的抑郁和焦虑异常,应对其相关危险因素给予更多关注。     

阿霉素神经干注射治疗三叉神经痛的护理

原发性三叉神经痛的病因和发病机制迄今尚未明了 ,因此临床上尚缺乏针对病因的生物性治疗方法。三叉神经痛在保守治疗无效时 ,常采用外科治疗 ,目前在国内外开展的有颅外三叉神经周围支撕脱术、颅内感觉根切断术、血管减压术及射频热凝术等[1] 。但由于颅内手术及射频热凝术操作难度较大且手术风险大、并发症多 ,术后仍有复发 ,不易被病人接受。 1999年—2 0 0 3年我科采用阿霉素神经干注射治疗原发性三叉神经痛 18例 ,取得了良好的效果。现将其围术期的护理总结如下。1　临床资料1.1　一般资料　 1999年— 2 0 0 3年在我院口腔科门诊就诊的…     

The trigeminal vasculature pathology in patients with neuralgia

OBJECTIVE: To examine the possible pathological changes of the trigeminal vasculature in patients with neuralgia. BACKGROUND: Such a study has never been performed before. The alterations of the trigeminal vessels could have important pathophysiological implications in the trigeminal neuralgia pathogenesis. METHODS: The biopsy specimens for the electronmicroscopic (EM) and immunohistochemical examination were taken during a partial rhizotomy in 6 patients with trigeminal neuralgia and in 2 persons with trigeminal neuropathy. In addition, the 32 normal trigeminal nerves were used as the control specimens. RESULTS: The vascular pathological alterations were noticed in 3 out of 6 neuralgia patients. The EM study revealed signs of apoptosis or degeneration, respectively, of some endothelial and smooth muscle cells in the wall of the trigeminal arterioles. The immune reactions against CD31, CD34, and alpha-smooth muscle actin in these cells were weaker than in the control specimens, but stronger against factor VIII. In addition, the arteriolar basement membranes, which were thickened, showed an intense laminin, fibronectin, and collagen IV immunoreactivity. Similarly, some endothelial cells and pericytes of the intratrigeminal capillaries also showed signs of apoptosis or degeneration, respectively. Their basement membrane was very thick and showed an intense immune reaction against laminin, fibronectin, and collagen IV. CONCLUSION: The observed pathological changes of the trigeminal vasculature could be the primary factor, while demyelination of the trigeminal nerve fibers could be the secondary process in some patients with neuralgia.     

Efficacy of pregabalin in the treatment of trigeminal neuralgia

This prospective, open-label study aimed to evaluate the efficacy of pregabalin treatment in patients suffering from trigeminal neuralgia with and without concomitant facial pain. Fifty-three patients with trigeminal neuralgia (14 with concomitant chronic facial pain) received pregabalin (PGB) 150–600 mg daily and were prospectively followed for 1 year. The primary outcome was number of patients pain free or with reduction of pain intensity by > 50% and of attack frequency by > 50% after 8 weeks. Secondary outcome was sustained pain relief after 1 year. Thirty-nine patients (74%) improved after 8 weeks with a mean dose of 269.8 mg/day (range 150–600 mg/day) PGB: 13 (25%) experienced complete pain relief and 26 (49%) reported pain reduction > 50%, whereas 14 (26%) did not improve. Patients without concomitant facial pain showed better response rates (32 of 39, 82%) compared with patients with concomitant chronic facial pain (7 of 14, 50%, P  = 0.020). Concomitant chronic facial pain appears to be a clinical predictor of poor treatment outcome. PGB appears to be effective in the treatment of trigeminal neuralgia.     

CT及MR血管造影图像融合评估原发性三叉神经痛患者三叉神经入脑干区血管、神经及骨性结构的关系

目的 观察CT及MR血管造影(MRA)双模态图像融合评估原发性三叉神经痛(PTN)患者三叉神经入脑干区(REZ)血管、神经及骨性结构的关系的价值。方法 回顾性分析10例PTN患者头部CT及MRA,将数据三维可视化后,分别于CT与MRA图中选取9个解剖标记点进行配准,根据配准后标记点的欧氏距离选出5个融合标记点用于图像融合;计算融合标记点的配准误差(FRE),评估图像融合精度。基于MRA数据重建脑底动脉及神经模型,观察REZ处血管与三叉神经根的空间位置关系,判定PTN责任血管;测量并比较患侧与对侧责任血管与三叉神经根、三叉神经压迹及卵圆孔之间距离的差异。结果 10例图像融合精度均良好,标记点FRE为1.862~3.156 mm,PTN责任血管均为小脑上动脉。患侧小脑上动脉与三叉神经压迹距离[(0.531±0.153)mm]及与卵圆孔的距离[(20.955±1.147)mm]均小于对侧[(2.573±1.050)mm、(24.864±1.807)mm,P均<0.001],与三叉神经根的距离[(5.024±1.063)mm]与对侧差异无统计学意义[(5.971±1.292)mm,P=0.081]。结论 CT及MRA图像融合有助于定量观察PTN患者REZ血管与骨性结构及三叉神经根的毗邻关系。     

积极心理干预在老年三叉神经带状疱疹后神经痛介入手术中的应用

目的 探讨积极心理干预对老年三叉神经带状疱疹后神经痛介入手术患者的影响.方法 将86例老年三叉神经带状疱疹后神经痛介入手术患者按照随机数字表法分为研究组与对照组,各43例.两组均给予常规护理干预,研究组在此基础上给予积极心理干预,观察住院全程.干预前后采用视觉模拟评分法评定两组疼痛程度,采用焦虑自评量表、抑郁自评量表评...