原发性三叉神经痛颅外非半月节射频热凝治疗的护理

目的 探讨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的护理方法。 方法 回顾性总结并分析2013年1月—2015年6月嘉兴市第一医院疼痛科采用CT引导下经皮穿刺眶上孔、圆孔、卵圆孔行颅外非半月节射频热凝治疗的218例原发性三叉神经痛患者的临床操作及护理资料，重点关注术前护理准备、术中护理配合和术后护理观察与处理，以总结最佳护理方案，提高治疗效果和患者的就医满意度。 结果 218例原发性三叉神经痛患者中，第Ⅰ、Ⅱ、Ⅲ支分别为17例、89例、74例，Ⅰ+Ⅱ支、Ⅱ+Ⅲ支分别为13例、25例，分别接受了CT引导下经皮穿刺眶上孔、圆孔、卵圆孔及眶上孔+圆孔、圆孔+卵圆孔行颅外非半月节射频热凝治疗，其中215例1次治愈，3例有疼痛残留，再次射频后治愈，但原疼痛区均有不同程度感觉麻木，第Ⅲ支射频热凝后遗留不同程度的张口困难。术后发生面部肿胀29例，术后护理观察及时发现，经序贯冷、热敷处理后肿胀消退；所有患者均无损伤三叉神经非疼痛分支及其他并发症的情况发生。 结论 CT引导下颅外非半月节射频热凝治疗三叉神经痛镇痛效果确切，并发症仅为面部肿胀和原疼痛区感觉麻木，术前针对性的心理护理及充分的术前准备，术中的监测、给药和术后病情观察与健康宣教是患者得到有效治疗和提高患者就医满意度的重要保证。 

The Nursing of Radiofrequency thermocoagulation of extracranial non-semilunar ganglion for trigeminal neuralgia

Objective To investigate the nursing approach for patients who receive radiofrequency thermocoagulation of extracranial non-semilunar ganglion through percutaneous puncture guided by CT to treat primary trigeminal neuralgia. Methods Retrospective analysis and summary have been carried out for clinical operations and nursing documentation of 218 cases of radiofrequency thermocoagulation of extracranial non-semilunar ganglion to treat primary trigeminal neuralgia in department of pain management in the First Hospital of Jiaxing from January,2013 to June,2015.The operations were conducted by percutaneous puncture under CT guidance through the foramen supraorbitale,foramen ovale,or foramen rotundum.We focused on preoperative nursing preparation,intraoperative nursing cooperation and postoperative nursing observation and treatment,in order to summarize the best nursing program and improve the treatment effect and patient satisfaction. Results The 218 cases of primary trigeminal neuralgia were divided into 17 cases of pain from Ⅰ,89 cases of Ⅱ,74 cases of Ⅲ,13 cases of Ⅰ+Ⅱ,25 cases of Ⅱ+Ⅲ,receiving radiofrequency thermocoagulation of extracranial non-semilunar ganglion following CT guided percutaneous puncture through foramen supraorbitale,foramen rotundum,foramen ovale,foramina supraorbitale plus rotundum,and foramina rotundum plus ovale respectively.The pain disappeared immediately after single treatment in 215 cases.There were 3 patients who had residual pain,which disappeared after second radiofrequency treatment.Various degree of numbness in the original pain area after treatment was reported in all cases.Various degree of difficulty in opening the mouth was observed after radiofrequency thermocoagulation of Ⅲ nerve.Facial swelling was observed in 29 cases after operation,and was timely detected by nursing care of postoperative,which disappeared after sequential hot and cold compression therapy.There were no reports on the damage to the other trigeminal nerve branches responsible for the pain or other complications. Conclusion The analgesic effectiveness of CT guided radiofrequency thermocoagulation of extracranial trigeminal nerve non-semilunar ganglion has been confirmed.Complications are limited to facial swelling and feeling numbness in the original pain area.The psychology nursing care and adequate preparations before the operation,vital sign monitoring during the operation,careful observation on the patient's condition after medication and operation,and good health communication and education are key methods to ensure the effective therapy and patient satisfaction.