中西医结合治疗原发性三叉神经痛的疗效

目的观察中西医结合治疗原发性三叉神经痛的疗效及复发率。方法126例原发性三叉神经痛的患者分为治疗组、对照组各63例,分别采用西医、中西医结合的方法治疗。应用简式McGill疼痛问卷法分别于治疗前及治愈后进行评分;随访观察6个月及1年的复发率。结果治疗组治愈率高于对照组（P<0.05）,复发率低于对照组（P<0.05）。结论中西结合治疗原发性三叉神经痛能提高疗效,降低复发率。     

简化McGill疼痛问卷中文版在腰椎间盘突出所致坐骨神经痛患者中的适用性

摘要 目的：评价简化McGill疼痛量表（SF-MPQ）中文版的信度、效度以及敏感度,了解其在疼痛评估中的应用价值。 方法：采用SF-MPQ对186例腰椎间盘突出所致坐骨神经痛的患者进行疼痛测定来评价该量表。主要对SF-MPQ进行信度、效度以及敏感度3方面的评价：采用Cronbach α系数法评价量表的内部一致性;计算疼痛分级（PRI）、VAS和PPI三项得分间的相关系数来分析量表的标准效度;采用验证性因子分析评价量表的结构效度;使用配对设计的t检验进行治疗前、后测定得分均数间的比较,同时计算出效应尺度,以此评价量表的敏感度;此外用频数及其百分比描述选词项目数。 结果：该量表中总PRI的Cronbach α系数为0.664,PRI、VSA和PPI三者间的相关系数为0.398—0.538,3因子模型的拟合度优于2因子模型;该量表在治疗后能够较为灵敏地反映出疼痛缓解程度,效应尺度为1.19—3.25。 结论：SF-MPQ中文版的信度、效度尚可,敏感度较高,是一种有实用价值的疼痛评估工具。     

疼痛护理质量指标的建立及在三叉神经痛病人中的应用

[目的]探讨疼痛护理质量指标的建立及在三叉神经痛病人中的应用。[方法]2017年7月—2017年12月由神经外科运用护理质量评价体系建立疼痛护理质量评价指标,包括疼痛评估准确率、疼痛评估及时率、疼痛干预有效率、镇痛效果满意率、疼痛记录合理率,并应用疼痛护理质量评价体系对三叉神经痛病人进行疼痛质量管理,并对疼痛管理效果进行评价,实施持续质量改进,分别于疼痛护理质量指标实施前(2017年1月—2017年6月)及实施后(2017年7月—2017年12月)各选取三叉神经痛病人60例进行评价,比较两组疼痛控制效果、疼痛发作频率、不良反应及生活质量情况。[结果]实施后病人疼痛控制有效率、病人治疗满意率均高于实施前(P0.05),而并发症发生率低于实施前(P0.05)。实施后病人视觉模拟评分(VAS)低于实施前(P0.05),而疼痛发作频率少于实施前(P0.05),实施后三叉神经痛病人生活质量评分高于实施前(P0.05)。[结论]疼痛护理质量指标的建立能有效提高三叉神经痛病人疼痛管理效果,减少病人疼痛发作频率,降低相关并发症发生,提高病人生活质量。     

中西医结合治疗不完全性脊髓损伤后中枢性疼痛

目的探讨中西医结合疗法治疗不完全性脊髓损伤中枢性疼痛的治疗效果。方法采用耳压、生物反馈、电动按摩器和经皮神经电刺激仪相结合的中西医结合疗法治疗不完全性脊髓损伤中枢性疼痛患者12例,以McGill疼痛问卷(MPQ)和视觉模拟评分(VAS)于治疗前后对中枢性疼痛进行评测。结果与治疗前相比,治疗后MPQ中的PRI-S、PRI-T、NWC以及VAS有明显降低(P<0.01),PRI-A、PPI最大值降低(P<0.05)。结论中西医结合疗法对治疗脊髓损伤中枢性疼痛有一定的疗效。     

伽玛刀治疗三叉神经痛疼痛缓解时间分析

目的分析和总结采用双靶点伽玛刀治疗三叉神经痛术后疼痛缓解时间规律,为伽玛刀的临床治疗提供参考。方法 2005年1月-2011年1月,共147例原发性三叉神经痛患者于四川大学华西医院接受Leksell C型伽玛刀治疗。使用4 mm准直器在三叉神经根制作2个等中心靶点,中心剂量80～90 Gy,控制脑桥照射剂量<20 Gy。术后定期对患者进行随访,对疼痛缓解时间进行统计分析。结果 130例患者获得随访,随访时间11～64个月,平均28.7个月。术后疼痛完全缓解95例(73.1%),部分缓解29例(22.3%),无效6例(4.6%)。疼痛缓解时间4 h～12个月,平均3.6周,其中疼痛完全缓解患者的疼痛缓解时间明显短于部分缓解患者(P<0.05)。53例(40.8%)患者于术后出现术侧轻度面部麻木。结论患者术后疼痛缓解时间可能是预测伽玛刀治疗效果的重要因素,但疼痛缓解时间个体差异大,应进行长期随访观察。     

人文关怀同质化管理在三叉神经痛介入术疼痛护理中的应用

目的:探讨人文关怀同质化管理在三叉神经痛(TN)介入术疼痛护理中的应用效果。方法:对9名护理人员行人文关怀同质化管理,以人文关怀同质化管理实施时间为界限(2018年11月1日),选取2017年11月1日～2018年10月31日行常规护理管理的31例TN患者为对照组,选取2018年11月1日～2019年10月31日在常规护理管理基础上结合人文关怀同质化管理的39例TN患者为实验组;比较两组疼痛管理能力、围术期睡眠时间(术前1 d、手术当天、术后3 d睡眠时间)、入院时及出院时负性情绪[采用汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)]、护理满意度。结果:实验组主动汇报疼痛、使用药物镇痛比例高于对照组(P0.05);实验组术前1 d、手术当天、术后3 d睡眠时间长于对照组(P0.05);出院时,两组HAMA、HAMD评分均低于入院时(P0.05),且实验组低于对照组(P0.01);实验组护理满意度高于对照组(P0.05)。结论:人文关怀同质化管理应用于TN介入术疼痛护理中,可增强患者疼痛管理能力,改善睡眠质量,调节心理状态,提高护理满意度。     

原发性三叉神经痛病人的疼痛控制与护理进展

综述原发性三叉神经痛病人的疼痛控制与护理进展,为更好地减轻病人疼痛提供依据。     

简化McGill疼痛评分表的临床应用评价

采用简化McGill疼痛评分表(简化MPQ)测定147例疼痛病人。简化MPQ主要包括6项指标:选词项目数、疼痛分级指数(PRI)感觉分、情绪和总分、目测类比定级(VAS)与现有疼痛强度(PPI)。分析结果信度系数0.85～0.98,效度系数0.48～0.91,具有高度显著性相关。对急性痛、慢性痛,术后痛患者的疼痛性质、强度、以及治疗前后进行了比较。表明简化MPQ信度高、效度好、简便易行、指标定量,是一种有实用价值的临床疼痛测定工具。     

3D-FIESTA在三叉神经痛诊断中的应用

目的:对磁共振MR三维稳态进动快速成像序列(three-dimensional fast imaging employing steady stateacquisition,3D-FIESTA)诊断三叉神经痛(TN)血管神经压迫的价值进行评价.方法:临床诊断TN 29例,先行SE T1WI、T2WI扫描,然后利用高分辨3D-FIESTA图像,观察神经与血管的关系,判断有无血管压迫神经,其中9例与手术结果对照.结果:3例为肿瘤所致,22例为血管压迫引起,4例未发现病因.结论:MRI对发现TN病因具有重要价值,特别是3D-FIESTA原始图像是显示神经血管接触的敏感方法,对选择手术方法具有重要的指导意义.     

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.     

应用MRI特殊序列诊断在三叉神经痛和面肌痉挛价值

INTRODUCTIONManyfactorsincludingneurovasuclarcompression（NVC）arecon－tributedtotrigeminalneuralgiaandfacialspasm，andNVCcanbecorrectedbymicrovesselsdecompression犤１犦．Currently，evidencesabouttheroleofneurovascualrcompressionintrigeminalneuralgiaandfacialspasmisunavailable，andforwhichimagingexaminationisconcentratedondiagnosisorexclusionofoccupyinglesions．MATERIALSANDMETHODSMaterials１５subejctswithclinicallyconfirmedunilateraltrigeminalneuralgiaincluding９menand６womenaged…     

Familial trigeminal neuralgia: case reports and review of the literature

The paroxysmal facial pain of trigeminal neuralgia is usually idiopathic, but familial cases have been described. We describe a family with apparent autosomal dominant transmission of trigeminal neuralgia. Our cases and a review of the literature suggest that the etiology of trigeminal neuralgia may be vascular compression of the fifth cranial nerve. Autosomal dominant vascular and epileptic disorders are reviewed, and possible relationships to familial trigeminal neuralgia are considered.     

A型肉毒毒素治疗三叉神经痛和带状疱疹后神经痛的临床疗效

目的：观察A型肉毒毒素治疗三叉神经痛和带状疱疹后神经痛的临床效果。方法：选取33例三叉神经痛或带状疱疹后神经痛患者，进行疼痛区域A型肉毒毒素皮下或皮内注射治疗，评估患者治疗时、治疗2周后、治疗3个月后疼痛情况（NRS）、睡眠状况及生活质量（QOL），判断治疗效果，观察药物不良反应。结果：患者使用A型肉毒毒素治疗2周后、3个月后疼痛评分、睡眠评分显著低于治疗时（P<0.05），生活质量显著高于治疗时（P<0.05），治疗效果好，不良反应少。结论：A型肉毒毒素治疗三叉神经痛和带状疱疹后神经痛效果显著，可成为神经病理性疼痛治疗的一种新途径。     

Subclinical sensory abnormalities in trigeminal neuralgia

Trigeminal neuralgia is considered as a paroxysmal single nerve phenomenon. Abnormal sensory perception has been previously described in 15-25% of patients with clinical examination. Quantitative sensory testing (QST) was used to evaluate sensory perception in patients with idiopathic trigeminal neuralgia (ITN). Nine patients and 10 normal control subjects were evaluated in all six trigeminal branches. QST abnormalities were found in the symptomatic division and in the other two branches on the same side. Minor contralateral changes were also found. Differences consisted of cold and warm hypoaesthesia and higher cold and heat pain thresholds in patients. All differences proved statistically significant. Our findings suggest that trigeminal neuralgia is not only a paroxysmal single nerve disorder, but also that other higher structures may be involved.     

Factorial validity of the short-form McGill pain questionnaire (SF-MPQ).

Although widely used, there have been few investigations of the factorial validity of the short-form McGill Pain Questionnaire (SF-MPQ; Melzack, 1987). Confirmatory factor analysis was performed on item responses to the SF-MPQ obtained from 188 patients with chronic back pain. Consistent with the original structure proposed by Melzack (1987), results indicated that the SF-MPQ is best represented by a two-factor solution. However, these findings are contrary to results obtained by Burckhardt and Bjelle (1994) who, using their Swedish version of the SF-MPQ, obtained a three-factor solution. Potential explanations for the disparity between the results of the two studies are explored and recommendations for continuing clinical and research applications are offered.     

Sensory and autonomic measurements in idiopathic trigeminal neuralgia before and after radiofrequency thermocoagulation: differentiation from some other causes of facial pain

1. (1) Quantitative measurements of somatosensory thresholds and skin temperature were made before (24 cases), 3–5 days after (12 cases), and 6 months after (11 cases) successful radiofrequency thermocoagulation of the proximal root and gasserian ganglion in 24 cases of idiopathic trigeminal neuralgia (TGN), 18 of whom had not previously undergone any interventional procedure; and in 3 cases of compressive non-TGN neural and 4 of non-neural facial pain at presentation.

2. (2) There were no differences in somatosensory thresholds between the skin innervated by the affected divisions and the unaffected mirror-image areas in previously unoperated cases of TGN and non-neural facial pain (‘atypical facial pain’) prior to operative intervention; but there were significant differences in tactile (von Frey) thresholds in the cases of non-TGN facial pain of neural origin.

3. (3) In TGN immediately after operation, thresholds for all modalities except cold sensation were significantly raised. Six months later, tactile and tragus pinch pain thresholds had returned to normal; but thresholds for warmth, hot pain, and pinprick remained elevated. However, in cases who had had previous procedures for TGN between 9 months and 5 years earlier, all thresholds except pinprick and possibly hot pain had returned to normal.

4. (4) Prior to operation for TGN, the skin temperature in the affected division was significantly lower than that in the contralateral unaffected division, presumably due to vasoconstriction. In previously operated cases in whom TGN had re-appeared, cutaneous vasoconstriction was also demonstrated. This was also true of the 3 non-TGN cases suffering from neurogenic pains presumably due to nerve compression, but not of the non-neural cases (‘atypical facial pain’).

5. (5) In parallel with pain relief of TGN by radiofrequency thermocoagulation, skin temperatures had risen by the first postoperative examination to equal those on the normal side and remained so 6 months later provided pain remained absent.

6. (6) It is suggested that cutaneous vasoconstriction plays a role in the pathophysiology of TGN, and that the origin of this and other changes is central rather than peripheral; but certain questions remain to be answered before this hypothesis can be definitely established.