延髓腹侧微血管减压术对高血压患者血压影响的临床分析  

Effect on blood pressure of primary hypertension patients received MVD operation on ventrolateral medulla a clinical study

作　　者：梁维邦[1] 倪红斌[1] 陆天宇[1] 吴俊[1] 金伟[1] 徐武[1] 蒋健[1] 

机构地区：[1]南京大学医学院附属鼓楼医院神经外科,南京210008

出　　处：《立体定向和功能性神经外科杂志》2010年第4期224-228,共5页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的评价微血管减压手术在治疗颅神经疾病的同时,局部延髓腹侧血管减压对高血压病患者的血压水平的影响。方法自2007年7月至2009年7月我院收治并行微血管减压手术治疗的45例颅神经疾病(包括面肌痉挛、三叉神经痛等)同时合并有明显高血压病的患者,排除肾性、内分泌性等继发因素引起的高血压病。其中左侧28例(62.2%),右侧17例(37.8%)。岩尖部薄层MRI平扫明确延髓腹侧及颅神经根部血管压迫情况,行微血管减压手术探查后组颅神经周围,对延髓腹侧造成压迫的血管进行移位、减压。术前及术后监测患者血压水平,术后随访1～2年了解其血压恢复情况,并与术前血压情况进行对比。结果本组所有患者未见明显严重并发症。随访示患者高血压情况有较为明显的改善,本组高血压症状治愈16例(35.6%),好转14例(31.1%),有效11例(24.4%),无效4例(8.9%)。左侧组28例,治愈11例(39.3%),好转10例(35.7%),有效6例(21.4%),无效1例(3.6%);右侧组17例,治愈5例(29.4%),好转4例(23.6%),有效5例(29.4%),无效3例(17.6%)。结论本研究结果提示合并颅神经疾病的高血压病患者行微血管减压手术后,血压水平可得到一定程度的控制,使交感神经兴奋性下降,解除了高血压发病环节中的神经因素从而使血压下降。临床工作中当患者出现原发性高血压病同时伴有颅神经疾病时,可同时行颅神经及延髓腹侧血管减压,当患有原发性难治性高血压者,若影像学提示异位血管压迫延髓的依据时,可考虑行手术治疗。Objective To analyze the effect of microvascular decompression operation on ventrolateral medulla on blood pressure in primary hypertension patients.Methods We described 45 cases in our department who suffered with both skull nerve diseases（including hemi-facial spasm and trigeminal neuralgia） and primary hypertension and received MVD operation from July,2007 to July 2009.All patients were of no disorder in urinary and endocrine system.28 cases suffered left nerve disease and 17 right.All patients received lamellar pars petrosa MRI examination to evaluate the pression ways of ectopic vessels and the possible difficulties in operation.We expose the IX,X and XI skull nerve and then put several pieces of Teflon in the right place between the nerve and the criminal vessel.REZ（medullary root entry zone,REZ）should also be decompressed.In the follow up in 1～2 years,we compared the BP level of these cases before and after the operation to evaluate the effect on BP of MVD.III.Results No serious complications happened.Levels of blood pressure went down after the operation.In the study of hypertension,the result showed： 16 cases were cured（35.6%,11 were in the left and 5 in the right）,14 cases improved（31.1%,10 in the left and 4 in the right）,11 cases were effective（24.4%,6 in the left and 5 in the right）,however,4 cases were invalid（8.9%,1 in the left while 3 in the right）.Conclusion Our research showed that the blood pressure of primary hypertension patients who suffers skull nerve diseases（such as hemi-facial spasm and trigeminal neuralgia） at the same time can be lowered by MVD operation.The mechanism may lies in that the activation of vagus nerve will be stronger and sympathetic nerve inhibited when ventrolateralis medullae oblongatae is decompressed.This will cause he beginning of hypertension by inhibiting the left heart.We can conclude from this study that MVD operation can cause a lowering of BP in hypertension patients besides its curative effect of skull nerve diseases.When a patie

关 键 词：微血管减压术 原发性高血压 延髓入脑干区 外科治疗 

分 类 号：R544.1[医药卫生—心血管疾病]