| Objective:Trigeminal neuralgia(TN)is a common neurological disease of the brain,Recurrent paroxysmal severe pain in the trigeminal nerve distribution area on one side is the main manifestation.The characteristics of the disease are the sudden onset,sudden stop,lightning,knife cut,burning,intolerable severe stubborn pain in the trigeminal nerve distribution area of the head and face.Percutaneous compression of the trigeminal ganglion(PCTG)is a minimally invasive procedure for the treatment of TN,the advantages of this technology are low trauma and high repeatability success rate,however,it can cause the sudden rise in blood pressure,sudden drop in heart rate(HR),and even sudden arrest simultaneously during the operation,these significant hemodynamic changes will bring unpredictable potential risks to patients.Most of the patients with TN tend to be the elderly,whose blood pressure fluctuates greatly,especially systolic blood pressure(SBP).This is mainly due to the decrease of reflex sensitivity caused by the decrease of vascular baroreceptor sensitivity in the elderly.In addition,the characteristics of the elderly’s artery are atherosclerosis,elastic regression,and many factors lead to the poor cardiovascular and cerebrovascular reserve capacity of the elderly.Therefore,PCTG-induced TCR during TN treatment can greatly increase the risk of cardiovascular and cerebrovascular accidents.Significant hemodynamic changes associated with PCTG treatment of TN have also received increasing attention from researchers.In the preliminary work of the research group,the most commonly used antihypertensive drug in clinic,sodium nitroprusside(SNP)was used as a drug selection to prevent sudden increase of blood pressure during the operation.During the study,pumping 0.5μg/kg/min SNP before the operation can significantly suppress the sudden rise of blood pressure during compression,but can not reduce the incidence of sudden drop in HR or sudden arrest.In addition,intravenous bolus injection of 0.004mg/kg atropine before surgery can significantly reduce the incidence of sudden drop in HR or sudden arrest,but can not reduce the incidence of sudden rise in blood pressure.Previous work had been insufficient in the observation of hemodynamic related parameters,which seriously affected the in-depth clinical study of relevant TCR in the prevention of PCTG treatment of TN.For the current TCR study,there were many studies on peripheral and central TCR,but the research on ganglion-related TCR was very rare.In addition,this abnormal hemodynamic change(HR drop and blood pressure rise coexist simultaneously)during PCTG in treatment of TN rarely occured in other types of TCR.Since the PCTG-related TCR has only received attention in recent years,there is a lack of detailed reports on changes in cardiovascular and cerebrovascular parameters associated with PTG treatment and related drug pretreatment.With the continuous emergence and introduction of advanced monitoring instruments,TCR research during PCTG in treatment of TN has been deepened in clinic.We realized that we need to pay more attention to the clinical observational study of cardiovascular and cerebrovascular parameters,and to give drug pretreatment in combination with cardiovascular and cerebrovascular parameters.Therefore,this study will explore the changes of cardiovascular and cerebrovascular parameters during the treatment of TN with PCTG and related drug pretreatment and how to reduce the incidence of TCR related to PCTG in the treatment of TN.Methods:300 patients with TN treated by PCTG were randomly divided into five groups:control group(saline pretreatment group)(Group A:intravenous injection of saline before puncture,n=60),sodium nitroprusside(SNP)pretreatment group(Group B:intravenous pump injection of 0.5μg/kg/min SNP before puncture,n=60),atropine pretreatment group(Group C:intravenous injection of 0.004mg/kg atropine before puncture,n=60),remifentanil pretreatment group(Group D:intravenous infusion of remifentanil 1μg/kg,n=60)and propofol pretreatment group(Group E:intravenous infusion of propofol 1～2 mg/kg,n=60).Group A,B,C,and D maintained normal anesthesia(Bispectral Idex,BIS value:40-60),and Group E maintained deep anesthesia(BIS value:<40).Time points of observation in each group:T1,before anesthesia induction;T2,after anesthesia induction;T3,before puncture;T4,during puncture;T5,needle enters oval hole;T6,compression;T7,after compression;T8,before laryngeal mask(LMA)extraction;T9,after LMA extraction.The observed indicators of each group:Systolic Blood Pressure(SBP),Diastolic Blood Pressure(DBP),Mean Arterial Pressure(MAP),Heart Rate(HR),Cardiac Output(CO),Stroke Volume Variability(SVV),Heart Rate Variation(HRV),System Vascular Resistance(SVR),regional cerebral oxygen saturation(rSO2)monitor and bispectral index(BIS),myocardial zymogram(creatinine kinase isoenzyme,CK-MB and high-sensitivity troponin,TNT-HS)(pre-operative and first morning after surgery)and the number of patients whose SBP,DBP and MAP values changed more than or equal to 20%and less than or equal to 20%at T4～T6 time points.Statistics:all statistical analysis was conducted with IBM SPSS statistics 18.0.Meanwhile,available data was analyzed and descriptive statistics was used to report baseline demographic data.Kolmogorov Smirnov test was used to analyze whether the parameters of the results are normal distribution.The measurement data were expressed as mean±standard deviation.The data analysis at different time points between groups was performed by multiple analysis of variance(MANOVA).Age and weight were analyzed by single factor analysis of variance(ANOVA).Pearsonχ~2test was used to analyze the number(ratio)described gender,disease location and the incidence of TCR and the number of patients whose SBP,DBP and MAP values changed more than or equal to 20%and less than or equal to 20%at T4～T6 time points.P<0.05 was significant difference.Results:The first part:the comparison between Group A and Group B showed that the SBP values at T4,T5 and T6 time points were significantly different(P<0.05),and the DBP values at T4～T9 time points were significantly different(P<0.05),the MAP values at T4～T9 time points were significantly different(P<0.05).The HR values at T5 time point and T9 time points were significant(P<0.05),and the CO value at T6time point was significantly different(P<0.05).The SVR values at T4,T5 and T6time points were significant(P<0.05),the SVV values at T4,T7 and T9 time points were significant(P<0.05),and the HRV values at T4～T7 time points were significantly different(P<0.05),and the TCR incidence of T5 time point was significantly different(P<0.05).In the SBP,there was significant difference between the two groups in the number of patients with change rate of≥20%at T5 time point and the number of patients with change rate of≤-20%at T4 and T5 time points(P<0.05);In the DBP,there was significant difference between the two groups in the number of patients with change rate of≥20%at T4～T5 time points and the number of patients with change rate of≤-20%at T4 and T5 time points(P<0.05);In the MAP,there was significant difference between the two groups in the number of patients with change rate of≥20%at T5 and T6 time points and the number of patients with change rate of≤-20%at T4 and T5 time points(P<0.05).In the Group A,the comparison between T4～T6 time points and T3 time point in the group showed that there was significant difference in the SBP values between the T5 and T6 time points(P<0.05),and the DBP values at the T4～T6 time points were significantly different(P<0.05),and the MAP values at the T4～T6 time points were significantly different(P<0.05),the difference of HR values at T5 and T6 time points was significant(P<0.05),and the difference of CO values at T4～T6 time points was significant(P<0.05),and the SVR values at T4～T5 time points were significantly different(P<0.05),and BIS values were significantly different at T4 and T6 time points(P<0.05),and SVV values were significantly different at T4 and T6 time points(P<0.05).There were significant differences in HRV values at T4～T6 time points(P<0.05),and there were significant differences in rSO2 values at T4～T6 time points(P<0.05);In Group B,there were significant differences in SBP values at T4 and T6time points(P<0.05),DBP values at T4 and T6 time points showed significant differences(P<0.05),MAP values at T4 and T6 time points showed significant differences(P<0.05),HR values at T5 and T6 time points showed significant differences(P<0.05),CO value at T4～T6 time points showed significant differences(P<0.05),SVR values at T4 and T5 time points showed significant differences(P<0.05),and BIS value at T6 time point showed significant difference(P<0.05).There were significant differences in the SVV values at T4 and T5 time points(P<0.05),and the HRV values at T4～T6 time points were significantly different(P<0.05).There was no significant difference in CK-MB value and TNT-HS value before operation and the first morning after operation(P>0.05).The second part:the comparison between Group A and Group C showed that there was significant difference in SBP value at T6 time point(P<0.05),and there were significant differences in DBP values at T5～T7 time points(P<0.05),there were significant differences in MAP values at T5～T7 time points(P<0.05),the HR values atT4～T9 time point were significantly different(P<0.05),and the CO values at T3～T8time points were significantly different(P<0.05).The SVR values at T5 and T6 time points were significantly different(P<0.05).The SVV value at T4 time point was significantly significant(P<0.05),and the HRV values at T4～T7 time points were significantly different(P<0.05).The BIS values at T7～T9 time points were significantly different(P<0.05).There were significant differences in the BIS values between T6 and T8 time points(P<0.05).In addition,there were significant differences in the incidence of TCR at T5 and T6 time points(P<0.05).In the SBP,there was no significant difference in the number of patients with a change rate of≥20%at any time point and the number of patients with a change rate of≤-20%at any time point(P>0.05);In the DBP,the difference in the number of patients with a change rate of≥20%at T6 time point between the two groups was significant(P<0.05)and the difference in the number of patients without a change rate of≤-20%at any time point was significant(P>0.05);In the MAP,there was no significant difference in the number of patients with a change rate of≥20%at any time point and the number of patients with a change rate of≤-20%at any time point(P>0.05).In the Group A,the comparison between T4～T6 time points and T3 time point in the group showed that there was significant difference in the SBP values between the T5 and T6time points(P<0.05),and the DBP values at the T4～T6 time points were significantly different(P<0.05),the MAP values at the T4～T6 time points were significantly different(P<0.05),the difference of HR values at T5 and T6 time points was significant(P<0.05),and the difference of CO values at T4～T6 time points was significant(P<0.05),and the SVR values at T4～T5 time points were significant differences(P<0.05),and BIS values were significant differences at T4 and T6 time points(P<0.05),and SVV values were significant differences at T4 and T6 time points(P<0.05).There was significant difference in HRV value at T4～T6 time points(P<0.05),and there was significant difference in rSO2 value at T4～T6 time points(P<0.05);In Group C,there were significant differences in SBP values at T5 and T6time points(P<0.05).There were significant differences in DBP values at T4 and T6time points(P<0.05),and the differences in HR values at T4 and T6 time points(P<0.05).There were significant difference in CO value between T4 and T6 time points(P<0.05).There were significant differences in SVR at T4 and T6 time points(P<0.05).There were significant differences in BIS values at T5 and T6 time points(P<0.05).There were significant differences in SVV values at T4 and T6 time points(P<0.05).There were significant differences in HRV values at T4 and T6 time points(P<0.05).There were significant differences in the values of rSO2 atT4～T6 time points(P<0.05).There was no significant difference in CK-MB value and TNT-HS value before operation and the first morning after operation(P>0.05).The third part:the comparison between Group A and Group D showed that there was no significant difference in SBP value at each time point(P>0.05),and there was significant difference in DBP value at T9 time point(P<0.05),and there was significant difference in DBP value at T9 time point(P<0.05).There were significant differences in HR values at T8 and T9 time points(P<0.05).There was no significant difference in CO value at each time point(P>0.05).The SVR value at each time point was no significant difference(P>0.05),and the SVV value at T4 time point showed significant difference(P<0.05).There were significant differences in HRV values at T4～T6,T8 and T9 time points(P<0.05).There were significant differences in BIS at T4 and T7～T9 time points(P<0.05).There was no significant difference in the value of rSO2 at each time point(P>0.05).There was no significant difference in the incidence of TCR at T5 and T6 time points(P>0.05).In the SBP,there was a significant difference in the number of patients with a change rate≥20%at the T6 time point(P<0.05)and no significant difference in the number of patients with a change rate≤-20%at any time point(P>0.05);In the DBP,there was a significant difference in the number of patients with a change rate of≥20%at the T5 time point between the two groups(P<0.05)and no significant difference in the number of patients with a change rate of≤-20%at any time point(P>0.05);In the MAP,the difference in the number of patients with a change rate of≥20%at the T6 time point between the two groups was significant(P<0.05)and the difference in the number of patients with a change rate of≤-20%at any time point was not significant(P>0.05).Comparing the T4～T6 time points with the T3 time point in the group,In the Group A,the comparison between T4～T6 time points and T3 time point in the group showed that there was significant difference in the SBP values between the T5 and T6 time points(P<0.05),and the DBP values at the T4～T6 time points were significantly different(P<0.05),and the MAP values at the T4～T6 time points were significantly different(P<0.05),the difference of HR values at T5 and T6 time points was significant(P<0.05),and the difference of CO values at T4～T6 time points was significant(P<0.05),and the SVR values at T4～T5 time points were significant differences(P<0.05),and BIS values were significant differences at T4 and T6 time points(P<0.05),and SVV values were significant differences at T4 and T6 time points(P<0.05).There was significant difference in HRV value at T4～T6 time points(P<0.05),and there was significant difference in rSO2 value at T4～T6 time points(P<0.05);.In group D,the SBP values at T5 and T6 time points were significantly different(P<0.05),and there were significant differences in DBP values at T5 and T6time points(P<0.05),and there were significant differences in MAP values at T5 and T6 time points(P<0.05).There were significant differences in HR values at T4 and T6 time points(P<0.05).There were significant differences in CO values at T4 and T6 time points(P<0.05).The differences of SVR values at T4～T6 time points were significant(P<0.05),and the difference of BIS value at T4 time point was significant(P<0.05).The differences of SVV values at T4～T6 time point was significant(P<0.05).<0.05),the difference of HRV values at T4～T6 time points were significant(P<0.05),and the differences of rSO2 values at T4～T6 time points were significant(P<0.05).There was no significant difference in CK-MB value and TNT-HS value before operation and the first morning after operation(P>0.05).The fourth part:the comparison between Group A and Group E showed that the differences of SBP values at T6 and T9 time points were significant(P<0.05),and the differences of DBP values at T5 and T8 time points were significant(P<0.05),and the differences of MAP values at T5 and T8 time points were significant(P<0.05).There was no significant difference in HR values at each time point(P>0.05).There were significant differences in CO values at T5 and T6 time points(P<0.05).The SVR values at T4～T6 were significant(P<0.05).The SVV value at T6 time point was significantly different(P<0.05).The differences of HRV values at T4,T5,T8 and T9time points were significant(P<0.05).The differences of BIS values at T5～T9 time points were significant(P<0.05),there was no significant difference in rSO2 values at each time point(P>0.05).There was no significant difference in the incidence of TCR at T5 and T6(P>0.05).In the SBP,the difference in the number of patients with a change rate of≥20%at the T5 and T6 time points was significant(P<0.05)and the difference in the number of patients with a change rate of≤-20%at the T4 time point was significant(P<0.05);In the DBP,there was a significant difference in the number of patients with a change rate of≥20%at T4～T6 time points(P<0.05)and no significant difference in the number of patients with a change rate of≤-20%at any time point(P>0.05);In the MAP,there was a significant difference in the number of patients with a change rate of≥20%at the T5 and T6 time points between the two groups(P<0.05)and no significant difference in the number of patients with a change rate of≤-20%at any time point(P>0.05).Comparing the T4～T6 time points with the T3 time points in the group,In the Group A,the comparison between T4～T6 time points and T3 time point in the group showed that there was significant difference in the SBP values between the T5 and T6 time points(P<0.05),and the DBP values at the T4～T6 time points were significantly different(P<0.05),and the MAP values at the T4～T6 time points were significantly different(P<0.05)the difference of HR values at T5 and T6 time points was significant(P<0.05),and the difference of CO values at T4～T6 time points was significant(P<0.05),and the SVR values at T4～T5time points were significant differences(P<0.05),and BIS values were significant differences at T4 and T6 time points(P<0.05),and SVV values were significant differences at T4 and T6 time points(P<0.05).There was significant difference in HRV value at T4～T6 time points(P<0.05),and there was significant difference in rSO2 value at T4～T6 time points(P<0.05);In Group E,the SBP values at T4～T6time points were significantly different(P<0.05),and there were significant differences in DBP values at T5 and T6 time points(P<0.05),and there were significant differences in MAP values at T5 and T6 time points(P<0.05).There were significant differences in HR values at T5 and T6 time points(P<0.05).There was significant difference in CO value at T4 time point(P<0.05).The differences of SVR values at T4～T6 time points were significant(P<0.05),and the differences of BIS values at T4～T6 time points were significant(P<0.05).The differences of SVV values at T4～T6 time point were significant(P<0.05).The differences of HRV values at T4～T6 time points were significant(P<0.05),and the differences of rSO2 values at T4～T6 time point were significant(P<0.05).There was no significant difference in CK-MB value and TNT-HS value before operation and the first morning after operation(P>0.05).Conclusion:Compared with the saline pretreatment group,SNP pretreatment can reduce the sudden rise of blood pressure by reducing the resistance of peripheral blood vessels,but the effect on HR is not great;atropine pretreatment can reduce the incidence of TCR,and increase hypertension by increasing CO;remifentanil pretreatment can not prevent sudden rise of blood pressure and sudden fall of HR;propofol pretreatment can reduce the sudden rise of blood pressure by reducing the sudden rise of the resistance of peripheral blood vessels,but the effect on HR is not great.All in all,single drug pretreatment can not prevent sudden rise of blood pressure and sudden fall of heart rate at the same time. |
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