三叉神经节射频热凝术中发生心律失常的临床分析

目的总结局麻下三叉神经节射频热凝术中出现的各种心律失常,为预防或减少术中发生不良反应提供依据。方法回顾性统计分析2005年1月～2008年1月我院412例局麻下行三叉神经半月节射频热凝术病例,其中297例术前未使用阿托品,115例术前肌注阿托品,统计心电监护记录中出现的各种心律失常的发生及出现的不良反应,并进行统计学分析。结果本组病例中新发窦性心动过缓81例（19.7%）,出现窦性停搏13例（3.2%）,发生阿斯综合征2例（0.4%）,出现心源性休克症状5例（1.2%）。其中阿托品组中发生窦性心动过缓55例,窦性停搏8例;未用阿托品组中发生窦性心动过缓26例,窦性停搏5例,术前使用阿托品对减少术中窦性心动过缓的发生经χ2检验无统计学意义。本组病例中出现窦性心动过速93例（22.6%）,出现新的房性期前收缩66例（16.0%）,室性期前收缩59例（14.3%）;室上性心动过速3例（0.7%）;心房纤颤1例（0.2%）。结论三叉神经半月节射频热凝术中可以出现快速或缓慢性心律失常,术前注射阿托品不能避免严重缓慢性心律失常的发生,加强术中心电监护是保证手术安全的关键。

Clinical analysis of arrhythm which occurred during percutaneous radiofrequency themocoagulation for idiopathic trigeminal neuralgia

Objective To summarize different kinds of arrhythm which occurred during percutaneous radiofrequency themocoagulation for idiopathic trigeminal neuralgia and to provide grounds for preventing and reducing adverse reactions during operation. Methods Four hundred and twelve patients were included and analysed who were given an local anaesthesia operation of percutaneous radiofrequency thermorhizotomy for idiopathic trigeminal neuralgia during 2005.1 -2008.1. Among the 412 patients, 297 did not use atropine and 115 used atropine before operation. We evaluated and analysed statistically all kinds of arrhythmia and adverse reactions according to the electrocardiographic monitoring results. Results Eighty - one （ 19.7% ） patients had sinus bradycardia, 13 （ 3.2% ） had sinus arrest, 2 （0.4%） had Adame - Strokes syndrom and 5 （ 1.2% ） had acute cardiogenic shock. Fifty - five patients had sinus bradycardia and 8 had sinus arrest in atropine - injection group. Twenty - six patients had sinus bradycardia and 5 had sinus arrest in non - atropine- injection group, there was no significant difference between these two groups. Among the 412 patients, 93 （ 22.6% ） had sinus tachycardia, 66 （ 16.0% ） had atrial premature beats, 59 （ 14.3% ） had ventricular premature beats, 3 （0.7%） had supraventricular tachycardia and 1 （0.2%） had atrial fibrillation. Conclusion Bradycardia arrhythmia or tachycardia arrhythmia occurred during operation of percutaneous radiofrequency thermorhizotomy. Atropine injection before the operation can not avoid occurrence of bradyeardia arrhythm. It is critical to strengthen the cardiac monitoring in order to assure the safety of the operation.