神经性高血压病因及外科治疗的临床分析

Clinical study of the etiology and surgical treatment of neurogenic hypertension

目的:探讨神经性高血压的病因及外科治疗方法.方法:对285例神经性高血压,其中伴三叉神经痛者265例.面肌痉挛者13例,舌咽神经痛者7例.采用局麻耳后小切口开颅,行三叉神经、面神经、舌咽神经血管减压术或行三叉神经感觉根部分切断术等,对部分三叉神经痛病人行术前、术后24h尿儿茶酚胺测定.结果:伴高血压者尿儿茶酚胺术后较术前明显下降(P<0.01),术后脑神经症状解除,高血压得以控制,89%的病人血压至今仍正常,其余服药量减少.结论;认为神经性高血压与疼痛刺激和情绪紧张有明显关系.从临床治疗初步观察来看,与左、右侧手术及是否探查延髓左侧、Ⅸ、Ⅹ神经无明显关系.

To discuss the etiology and surgical treatment of neurogenic hypertension. Method: Two hundred and eighty five cases of neurogenic hypertension were presented, among the 280 cases, 265 with trigeminal neuralgia, 13 with facial spasm and 7 with glossopharyngeal neuralgia. Microvascular decompression of cranial nerve V , VII ,IX and selective rhizotomy of trigeminal nerve were performed under local anesthesia via a small retroauricular suboccipital craniotomy. 24-hour urine samples for catecholamines were determined , preoperatively and postoperatively in some patients with trigeminal neuralgia. Result: The postoperative catecholamine level was lower than that of preoperative value obviously ( P <C 0.01 ), and the hypertension was controlled. Conclusion; There was obvious relation between neurogenic hypertension and pain irritation and/ or emotional tension. There was no obvious relation between the left or right side lesions and whether or not to explore the left medulla oblon-gata or cranial nerve IX , X