面肌痉挛术后迟发性面瘫发生的Logistic回归分析
陈永军1，2） 张 恒1） 孙华东2） 曾 辉1）
1）四川大学华西医院，四川 成都 610041
2）三六三医院，四川 成都 610000
通信作者：张恒
【摘要】 目的 探讨影响面肌痉挛术后迟发性面瘫（DFP）发生的相关危险因素，并提出针对性的预防措施。方法 回顾性纳入 2018-06—2020-06 于四川大学华西医院行显微血管减压术（MVD）的面肌痉挛（HFS）患者 307 例。术后门诊或电话随访，评估 DFP 发生及恢复情况。将术后发生 DFP 患者作为观察组，将术后未发生 DFP 患者作为对照组。统计 2 组患者一般资料，对正态分布的连续变量采用t 检验；非正态分布的连续变量采用非参数秩和检验；计数数据采用χ2 检验；以多因素Logistic 回归分析影响患者术后发生 DFP 的危险因素；采用 Pearson 检验分析 DFP 发生时间与症状持续时间的相关性。结果 307例患者随访 3~12（8.34±2.15）月；术后 1 周内并发症发生率为 13.36%（41/307）；术后 DFP 发生率为 10.10%（31/307），均于术后 2 个月内发生，并于发生后 1 a 内完全恢复正常。31 例 DFP 患者发生时间为术后 18（5，46）d，恢复正常时间 117（17，222）d。2 组患者性别、年龄、合并基础疾病、患侧、吸烟、饮酒、术前保守治疗情况、Cohen 分级、责任血管类型比较差异无统计学意义（P>0.05）；观察组术前病程>5 a，责任血管数≥2 条，面神经有压痕、围术期使用尼莫地平占比分别为 67.74%（21/31）、58.06%（18/31）、64.52%（20/31）、70.97%（22/31），明显高于对照组的 42.03%（116/276）、25.00%（69/276）、34.42%（95/276）、46.01%（127/276），差异有统计学意义（P<0.05）。多因素 Logistic 回归分析显示，术前病程>5 a、责任血管数≥2、面神经有压痕是术后发生 DFP 的危险因素（P<0.05）；围术期尼莫地平使用是术后发生 DFP 的保护因素（P<0.05）。Pearson 相关性分析结果显示，DFP 发生时间与症状持续时间呈正相关（r=0.896，P<0.001）。结论 术前病程越长、责任血管数越多以及面神经有压痕，则术后出现 DFP 可能性越高，而围术期使用尼莫地平则可减少 DFP 的发生。早治疗、术中轻柔操作、保护面神经、术后及时对症支持治疗可减少 MVD 患者 DFP 的发生风险。
【关键词】 面肌痉挛；显微血管减压术；迟发性面瘫；危险因素
【中图分类号】 R745.1+2 【文献标识码】 A 【文章编号】 1673-5110 （2022） 04-0459-06
基金项目：四川省医学科研青年创新课题（编号：Q19021）
DOI：10.12083/SYSJ.220212
Logistics regression analysis of occurrence of delayed facial paralysis after hemifacial spasm surgery
CHEN Yongjun1，2），ZHANG Heng1），SUN Huadong2），ZENG Hui1）
1）West China Hospital，Sichuan University，Chengdu 610041，China
2）363 Hospital，Chengdu 610000，China
Corresponding author：ZHANG Heng
【Abstract】 Objective To explore the related risk factors affecting the occurrence of delayed facial paralysis（DFP）after hemifacial spasm surgery，and to propose the targeted preventive measures. Methods The clinical data of 307 patients with hemifacial spasm（HFS）who underwent microvascular decompression（MVD） in the hospital were retrospectively analyzed between June 2018 and June 2020. Postoperative outpatient serviceor telephone follow-up was performed to evaluate the occurrence of DFP and recovery status. The patients with postoperative DFP were enrolled as observation group，while the patients without postoperative DFP were included in control group. The general data of the two groups of patients were statistically analyzed，and t test was used for continuous variables with normal distribution and non-parametric rank-sum test was adopted for continuous variables with non-normal distribution. χ2 test was used for enumeration data. Multivariate Logistic regression analysis was used to analyze the risk factors of occurrence of postoperative DFP，and Pearson test was adopted to analyze the correlation between occurrence time of DFP and symptom duration. Results Totally 307 patients were followed up for 3 to 12 months，with an average of（8.34±2.15）months. The incidence rate of complications within 1 week after surgery was 13.36%（41/307）. The incidence rate of postoperative DFP was 10.10%（31/307）， all of which occurred within 2 months after surgery and returned to normal within 1 year after the occurrence. The occurrence time of 31 patients with DFP was 18（5，46）d after surgery，and the time of returning to normal was 117 （17，222） d. There were no statistical differences in gender，age，underlying diseases，affected side， smoking，drinking，preoperative conservative treatment status，Cohen classification and type of offending vessels between the two groups（P>0.05）. The proportions of preoperative course of disease >5 years，the number of offending vessels ≥2，facial nerve indentation and perioperative nimodipine use were 67.74%（21/31），58.06% （18/31），64.52% （20/31） and 70.97% （22/31） in observation group，which were significantly higher than 42.03%（116/276），25.00%（69/276），34.42%（95/276）and 46.01%（127/276）in control group（P<0.05）. Multivariate Logistic regression analysis showed that preoperative course of disease >5 years，the number of offending vessels ≥2 and facial nerve indentation were the risk factors of occurrence of postoperative DFP （P<0.05）. Perioperative nimodipine use was a protective factor of postoperative DFP （P<0.05）. Results of Pearson correlation analysis revealed that the occurrence time of DFP was positively correlated with the duration of symptom （r=0.896，P<0.001）. Conclusion The longer the preoperative course of disease，the more the offending vessels and the indentation of the facial nerve，the higher the possibility of postoperative DFP. And perioperative use of nimodipine can reduce the occurrence of DFP. Early treatment of patients with MVD，gentle operation during surgery，facial nerve protection and timely symptomatic and supportive treatment after surgery can reduce the risk of DFP.
【Key words】 Hemifacial spasm；Microvascular decompression；Delayed facial paralysis；Risk factors
