伴面神经和三叉神经受压的神经源性高血压的临床特征及显微血管减压术疗效评估  

Clinical characteristics of neurogenic hypertension with facial nerve and trigeminal nerve compression and efficacy of microvascular decompression

作　　者：陈纯娴[1,2] 潘忞 蔡文钦 谢良地[1,2] 邓璟 余良宏[3] CHEN Chun-xian;PAN Min;CAI Wen-qing;XIE Liang-di;DENG Jing;YU Liang-hong(Department of VIP Wards and Department of Hypertension,theFirst Affiliated Hospital of Fujian Medical University,Fuzhou,Fujian 350005,China;Fujian Hypertension Research Institute;Department of Neurosurgery,the First Affiliated Hospital of Fujian Medical University)

机构地区：[1]福建医科大学附属第一医院干部病房,高血压科,福建福州350005 [2]福建省高血压研究所 [3]福建医科大学附属第一医院神经外科

出　　处：《中华高血压杂志》2022年第12期1161-1167,共7页Chinese Journal of Hypertension

摘　　要：目的 探讨伴面神经、三叉神经受压的神经源性高血压的临床特征及采取显微血管减压术(MVD)对血压的影响。方法 回顾性分析2015年1月至2020年12月于福建医科大学附属第一医院神经外科治疗的伴面神经、三叉神经受压的神经源性高血压患者53例的资料。所有患者采用MVD进行治疗,记录术中、术后情况,观察术后3个月血压改变。根据血压下降幅度、药物使用情况及症状缓解程度进行疗效判定。治愈:完全停用降压药,收缩压<140和舒张压<90 mm Hg;显效:收缩压和舒张压中一项降至正常水平或收缩压下降值≥30 mm Hg和舒张压下降值≥10 mm Hg;部分缓解:收缩压下降值<30和舒张压下降值<10 mm Hg,高血压临床症状缓解,降压药用量减少;无效:高血压临床症状无缓解,收缩压和舒张压均较术前无明显变化甚至升高,且药物用量无变化甚至增加。有效包括治愈、显效及部分缓解。结果 面神经、三叉神经受压最常见的责任动脉为:小脑前下动脉(21例,占39.62%),小脑后下动脉(15例,占28.30%),小脑上动脉(11例,占20.75%)。与术前比较,术后3个月收缩压和舒张压下降[收缩压:(127.8±9.2)比(146.5±17.3)mm Hg,t=6.896,P<0.001;舒张压:(76.9±8.4)比(89.4±11.2)mm Hg,t=6.297,P<0.001]。治愈30例(56.60%),显效10例(18.87%),部分缓解5例(9.43%),无效8例(15.09%),显效率75.47%,有效率84.91%,且左侧神经受压患者术后有效率明显高于右侧神经受压患者[90.48%(19/21)比81.25%(26/32),χ^(2)=10.503,P=0.015]。所有患者的颅神经受压症状均消失并且未出现严重并发症。结论 MVD在治疗伴面神经、三叉神经受压的神经源性高血压方面有一定应用前景。Objective To investigate the clinical characteristics of neurotic hypertensives with compression on facial nerve or trigeminal nerve and the effects of microvascular decompression(MVD) on blood pressure. Methods The clinical data of 53 neurogenic hypertensive patients with facial or trigeminal nerve compression treated in neurosurgery department of the First Affiliated Hospital of Fujian Medical University from January 2015 to December 2020 were retrospective analyzed. The MVDs were performed in all patients. The intraoperative and postoperative conditions were recorded, especially the changes in blood pressure 3 months after surgery. The therapeutic effect was determined according to the blood pressure decline, drug use and the degree of symptom relief. Cure was defined as completely stop using antihypertensive drugs, systolic blood pressure(SBP) <140 and diastolic blood pressure(DBP) <90 mm Hg;marked effective was defined as SBP or DBP decreased to the normal level or SBP decreased ≥30 mm Hg and DBP decreased ≥10 mm Hg;partial relief was defined as the decrease of SBP<30 and DBP<10 mm Hg, the clinical symptoms of hypertension were relieved, and the dosage of antihypertensive drugs was reduced;Ineffective was defined as the clinical symptoms of hypertension were not relieved, SBP and DBP had no significant change or even increased after surgery, and the drug dosage had no change or even increased. Effective included cure, marked effective and partial remission. Results The most common responsible arteries for facial nerve and trigeminal nerve compression were: anterior inferior cerebellar artery(21 cases, 39.62%), posterior inferior cerebellar artery(15 cases, 28.30%), and superior cerebellar artery(11 cases, 20.75%). Compared with the preoperative period, postoperative SBP and DBP decreased significantly [SBP:(127.8±9.2) vs(146.5±17.3) mm Hg, t=6.896, P<0.001;DBP:(76.9±8.4) vs(89.4±11.2) mm Hg, t=6.297, P<0.001]. Among all patients, 30 patients were cured(56.60%), 10 cases were marked effective(18.87%),

关 键 词：显微血管减压术 神经源性高血压 降压疗效 

分 类 号：R544.1[医药卫生—心血管疾病] R651.3[医药卫生—内科学]