显微血管减压术治疗神经性高血压的疗效分析

Therapeutic evaluation of left medullary microvascular decompression on neurogenic hypertension

【摘要】目的探讨显微血管减压术治疗神经性高血压的疗效。方法自2009年9月到2011年6月间，采取显微血管减压术治疗脑神经疾病患者中36例术前伴有神经源性高血压。对12例合并有高血压的左侧脑神经疾病患者进行左侧延髓腹外侧区显微血管减压手术，术前及术后监测患者血压、血管紧张素A2、醛固酮水平，术后随访6～25个月，平均时间10个月。观察其血压恢复情况。结果随访示患者高血压情况有较为明显的改善，行左侧延髓腹外侧区显微血管减压手术探查12例患者术后高血压治愈3例；显效5例；有效3例；无效1例。术后较术前血清血管紧张素、醛固酮均有降低，差异有统计学意义（P〈0．05）。未行左侧延髓腹外侧区显微血管减压手术探查组24例术后高血压治愈3例；显效6例；有效8例；无效7例。结论异常血管袢压迫脑神经根及延髓，长期疼痛刺激和情绪紧张是神经性高血压的病因之一，行左侧延髓腹外侧区的显微血管减压术可使神经源性高血压患者的血压下降。

Objective To investigate the effect of microvascular decompression（MVD） in patients with severe hypertension with microvascular comprssion（MVC） on blood pressure. Methods From September 2009 to June 2011, thirty-six cases of cranial nerve diseases who also suffered with primary hypertension before MVD operation, and 12 cases suffered with hypertension of the left cranial nerve disease received MVD operation on the left ventrolateral medulla. The BP and hormone levels of these cases were compared before and after the operation to evaluate the effective on BP of MVD, and to observed the BP levels in 6-25months. Results Twelve cases received MVD operation on the left ventrolateral medulla and the result showed：three cases were cured, five cases improved, three cases were effective, however, one cases were invalid. Levels of serum angiotensin A2 and aldosterone went down after the operation （P 〈 0. 05）. Twenty-four cases did not receive MVD operation on the left ventrolateral medulla and the result showed：three cases were cured, six cases improved eight cases were effective, seven cases were invalid. Conclusion A more significant improvement in follow-up shown in patients with high blood pressure. It was pathogenesis of neurogenic hypertension that oppressing cranial nerve roots and the medulla oblongata by abnormal vascular loop leads to long term aching stimulation and emotional stress, MVD operation on the left ventrolateral medulla is an effective treatment of neurogenic hypertension.