围术期应用尼莫地平对面肌痉挛患者面神经微血管减压术后并发症的影响
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摘要
目的:探讨围手术期应用尼莫地平对面肌痉挛(HFS)患者面神经微血管减压术(MVD)术后并发症的影响。方法:收集2010年3月至2015年3月在湖北省医药学院附属人民医院接受MVD治疗的HFS患者142例,分为对照组与观察组,每组71例。对照组术前不用药,术后第1天开始静脉注射尼莫地平,第5天改为尼莫地平片口服治疗10d;观察组术前1d至术后第4天静脉注射尼莫地平,第5天改为尼莫地平片口服治疗10d。对比两组手术情况、术后周围性面瘫(PFP)、听力障碍等并发症发生情况。结果:两组术中所见责任血管压迫区域、手术时间、术中出血量及临床疗效比较差异无统计学意义(P>0.05);术后7d,观察组的头晕、耳鸣、听力障碍及PFP发生率均显著低于对照组(均P<0.05);术后6个月,观察组的累计听力障碍及PFP发生率显著低于对照组(P<0.05);观察组的PFP发生时间较对照组延迟(P<0.05),持续时间较对照组明显缩短(P<0.05),且PFP程度显著低于对照组(P<0.05);术后7d、6个月,观察组的听力显著高于对照组(P<0.05)。结论:术前持续应用尼莫地平能够有效保护HFS患者MVD术中颅神经功能损伤,降低术后PFP及听力障碍发生率。
Objective:To investigate the effect of nimodipine using in the perioperative period on postoperative complications after microvascular decompression(MVD)in hemifacial spasm(HFS)patients.Methods:142HFS patients underwent MVD surgery in our hospital from March 2010 to March 2015 were selected and divided into a control group and an observation group,with 71 cases in each group.All patients administered nimodipine via intravenous infusion for 4days and then took nimodipine tablets orally for 10 days after surgery,and those in the observation group were also administered nimodipine 1day before surgery.The postoperative complications were observed and compared between the two groups.Results:There were no significant differences in the operative time,intraoperative blood-loss and vascular compression areas between the two groups(P >0.05).The incidence of dizziness,tinnitus,hearing disorder and facial paralysis in the observation group was significantly lower than those in the control group at 7days after operation(P <0.05).The incidence of peripheral facial paralysis(PFP)and the degree of hearing impairment in the observation group were significantly lower than those in the control group at 6months after operation(P <0.05).The occurrence time and duration of PFP in the observation group were shorter than those in the control group(P <0.05).At seven days and six months after operation,the audition in the observation group was superior to that in the control group(P <0.05).Conclusion:Treated with nimodipine before operation could effectively prevent cranial nerve dysfunction,and reduce the incidence of postoperative PFP and hearing disorders in HFS patients who underwent MVD.
Objective:To investigate the effect of nimodipine using in the perioperative period on postoperative complications after microvascular decompression(MVD)in hemifacial spasm(HFS)patients.Methods:142HFS patients underwent MVD surgery in our hospital from March 2010 to March 2015 were selected and divided into a control group and an observation group,with 71 cases in each group.All patients administered nimodipine via intravenous infusion for 4days and then took nimodipine tablets orally for 10 days after surgery,and those in the observation group were also administered nimodipine 1day before surgery.The postoperative complications were observed and compared between the two groups.Results:There were no significant differences in the operative time,intraoperative blood-loss and vascular compression areas between the two groups(P >0.05).The incidence of dizziness,tinnitus,hearing disorder and facial paralysis in the observation group was significantly lower than those in the control group at 7days after operation(P <0.05).The incidence of peripheral facial paralysis(PFP)and the degree of hearing impairment in the observation group were significantly lower than those in the control group at 6months after operation(P <0.05).The occurrence time and duration of PFP in the observation group were shorter than those in the control group(P <0.05).At seven days and six months after operation,the audition in the observation group was superior to that in the control group(P <0.05).Conclusion:Treated with nimodipine before operation could effectively prevent cranial nerve dysfunction,and reduce the incidence of postoperative PFP and hearing disorders in HFS patients who underwent MVD.
引文
[1]于海明,刘增良,杜爱平,等.围术期应用尼莫地平对面肌痉挛术后并发症的影响及临床意义[J].中国老年学杂志,2014,34(22):6320-6321.
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[4]林松,凌辉,雒仁玺,等.尼莫地平在防治微血管减压术后迟发性面瘫的作用[J].中国乡村医药,2015,22(20):31-32.
[5]上海交通大学颅神经疾病诊治中心.面肌痉挛诊疗中国专家共识[J].中国微侵袭神经外科杂志,2014,19(11):528-532.
[6]中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉科学分会.面神经功能评价标准[J].中华耳鼻咽喉头颈外科杂志,2006,41(1):22.
[7]陈茂华,朱迪海.尼莫地平对面肌痉挛患者微血管减压术后周围性面瘫及听力的影响[J].中国药房,2016,27(5):681-683.
[8]ZHONG J,XIA L,DOU LL,et al.Delayede relief of hemfacial spasm after micorvascular decompression[J].Acta Neurochir,2015,157(1):98-99.
[9]马玉召,王延伟,孙兴,等.微血管减压术治疗面肌痉挛及术后并发症治疗体会[J].河南外科学杂志,2013,19(2):118.
[10]詹傲,石全红,熊伟茗,等.尼莫地平在微血管减压术后迟发性面瘫防治作用中的研究[J].重庆医学,2014,34(22):2836-2838.
[11]朱婉茸,张扶莉,许韬,等.血管性痴呆患者采用不同治疗方法对其认知功能影响分析[J].国际精神病学杂志,2015,42(2):56-59.
[12]夏俊哲,陶钧,梁传声,等.尼莫地平静脉应用和术中灌洗对预防血管痉挛作用的临床研究[J].实用药物与临床,2009,12(3):166-168.
[13]BABU CS,RAMANATHAN M.Post-ischemic administration of nimodipine following focal cerebral ischemic-reperfusion injury in rats alleviated excitotoxicity,neurobehavioural alterations and partially the bioenergetics[J].Int J Dev Neurosci,2011,29(1):93-105.
[14]CHOI SK,LEE GJ,CHOI S,et al.Neuroprotective effects by nimodipine treatment in the experimental global ischemic rat model:real time estimation of glutamate[J].J Korean Neurosurg Soc,2011,49(1):1-7.櫚櫚櫚櫚櫚櫚櫚櫚櫚櫚櫚毎毎毎毎综述
[2]付莛凯,朱广廷,王翀,等.钙离子拮抗剂围手术期应用对面肌痉挛术后并发症的影响[J].中国临床神经外科杂志,2012,17(4):215-217.
[3]DENG Y,XU Z,XU B,et al.Excitotoxicity in rat's brain induced by exposure of manganese and neuroprotective effects of pinacidil and nimodipine[J].Biol Trace Elem Res,2009,131(2):143-153.
[4]林松,凌辉,雒仁玺,等.尼莫地平在防治微血管减压术后迟发性面瘫的作用[J].中国乡村医药,2015,22(20):31-32.
[5]上海交通大学颅神经疾病诊治中心.面肌痉挛诊疗中国专家共识[J].中国微侵袭神经外科杂志,2014,19(11):528-532.
[6]中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉科学分会.面神经功能评价标准[J].中华耳鼻咽喉头颈外科杂志,2006,41(1):22.
[7]陈茂华,朱迪海.尼莫地平对面肌痉挛患者微血管减压术后周围性面瘫及听力的影响[J].中国药房,2016,27(5):681-683.
[8]ZHONG J,XIA L,DOU LL,et al.Delayede relief of hemfacial spasm after micorvascular decompression[J].Acta Neurochir,2015,157(1):98-99.
[9]马玉召,王延伟,孙兴,等.微血管减压术治疗面肌痉挛及术后并发症治疗体会[J].河南外科学杂志,2013,19(2):118.
[10]詹傲,石全红,熊伟茗,等.尼莫地平在微血管减压术后迟发性面瘫防治作用中的研究[J].重庆医学,2014,34(22):2836-2838.
[11]朱婉茸,张扶莉,许韬,等.血管性痴呆患者采用不同治疗方法对其认知功能影响分析[J].国际精神病学杂志,2015,42(2):56-59.
[12]夏俊哲,陶钧,梁传声,等.尼莫地平静脉应用和术中灌洗对预防血管痉挛作用的临床研究[J].实用药物与临床,2009,12(3):166-168.
[13]BABU CS,RAMANATHAN M.Post-ischemic administration of nimodipine following focal cerebral ischemic-reperfusion injury in rats alleviated excitotoxicity,neurobehavioural alterations and partially the bioenergetics[J].Int J Dev Neurosci,2011,29(1):93-105.
[14]CHOI SK,LEE GJ,CHOI S,et al.Neuroprotective effects by nimodipine treatment in the experimental global ischemic rat model:real time estimation of glutamate[J].J Korean Neurosurg Soc,2011,49(1):1-7.櫚櫚櫚櫚櫚櫚櫚櫚櫚櫚櫚毎毎毎毎综述