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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 evaluate the effect of local decompression of medulla oblongata on blood pressure in hypertensive patients while treating cranial neuropathy under microvascular decompression. Methods From July 2007 to July 2009, 45 cases of cranial nerve diseases (including hemifacial spasm, trigeminal neuralgia and so on) treated by concurrent microvascular decompression in our hospital were treated with concurrent hypertension with obvious hypertension, , Endocrine and other secondary causes of hypertension. There were 28 cases (62.2%) on the left side and 17 cases (37.8%) on the right side. The petrous apexes of the medulla oblongata and cranial nerve roots were clearly scanned by thin-section MRI of the petrous apexes. The cranial nerves of the posterior group were examined by microvascular decompression. Preoperative and postoperative monitoring of patients with blood pressure levels, follow-up of 1 to 2 years to understand the recovery of blood pressure, and preoperative blood pressure were compared. Results All the patients in this group showed no obvious serious complications. Follow-up showed that there was a significant improvement in patients with hypertension. The symptoms of hypertension were cured in 16 cases (35.6%), improved in 14 cases (31.1%), effective in 11 cases (24.4%) and ineffective in 4 cases (8.9%). There were 28 cases in the left group, 11 cases were cured (39.3%), 10 cases (35.7%) were improved, 6 cases (21.4%) were effective and 1 case ), Improvement in 4 cases (23.6%), effective in 5 cases (29.4%), invalid in 3 cases (17.6%). Conclusions Our results suggest that hypertensive patients with cranial neuropathy may have some degree of control over blood pressure after microvascular decompression surgery, resulting in decreased sympathetic activity and dislocation of neurological factors in the pathogenesis of hypertension leading to increased blood pressure decline. Clinical work when patients with essential hypertension accompanied by cranial nerve disease, can simultaneously cranial nerves and medulla oblongata vascular decompression, when suffering from primary refractory hypertension, if imaging tips Ectopic vascular compression medullary basis, consider surgery.