摘要
目的探讨显微血管减压术（MVD）对脑神经疾患合并高血压患者的降压疗效以及术前MRI检查对手术的指导价值。方法回顾性纳入2015年1月至2016年10月西南医科大学附属医院神经外科收治的72例脑神经疾患合并高血压患者，术前行三维时间飞跃法磁共振血管成像（3D—TOF—MRA）评估血管与手术侧延髓头端腹外侧（RVLM）的关系。30例仅行相关脑神经的MVD（A组）；42例行相关脑神经的MVD以及RVLM区的探查或MVD（B组），其中32例行相关脑神经和RVLM区的MVD（C组），10例行相关脑神经的MVD以及RVLM区的探查（D组）。比较左、右两侧术前MRI检查的阳性发现率，监测术前及术后12个月的收缩压（SBP）和舒张压（DBP），评估手术有效率。结果术前MRI检查中，左侧阳性发现率高于右侧[分别为87．5％（35／40）和65．6％（21／32），P=0．027]。3D-TOF—MRA检查的灵敏度为85．7％（30／35），特异度为71．4％（5／7），准确度为83．3％（35／42）。A组术后血压与术前血压的差异无统计学意义（P SBP=0．067，P DRP=0．184）。C组术后血压较术前血压降低（左侧：P SBP〈0．01，P DBP〈0．01；右侧：P SBP〈0．01，P DBP〈0．01），其左侧与右侧的手术前后血压变化量（P△SBP=0．425，P△DBP=0．065）和手术有效率（P=0．703）的差异无统计学意义。结论MVD是治疗神经源性高血压的有效方法，左侧和右侧的手术降压疗效无明显差别。MRI检查有助于神经源性高血压的诊断。
Objective To explore the effect of microvascular decompression （MVD） on blood pressure in the treatment of hypertensive patients with cerebral nerve disorders and the value of preoperative MRI examination for the operation. Methods From January 2015 to October 2016, 72 hypertensive patients with cerebral nerve disorders were admitted to Department of Neurosurgery, the Affiliated Hospital of Southwest Medical University and enrolled into this retrospective study. We evaluated the relationship between vessels and rostral ventrolateral medulla （RVLM） in the surgical side before operation by 3 dimensional time of flight magnetic resonance angiography （3D-TOF-MRA）. Thirty cases underwent MVD of the root exit/entry zone （REZ） of the related cerebral nerves （group A） and the other 42 cases underwent exploration of RVLM or MVD of RVLM in addition to the related cerebral nerves （group B）. In group B, 32 cases received MVD of RVLM （group C ） and the other 10 cases merely received exploration of RVLM （group D ）. The positive rate of preoperative MRI examination was compared between two sides. SBP （systolic blood pressure） and DBP （diastolic blood pressure ） prior to operation and 12 months after operation were monitored, and the operative efficiency was evaluated. Results For preoperative MRI examination, the positive rate on the left and right sides was 87.5% （35/40） and 65.6% （21/32）, respectively, which was was significantly higher on the left side than the right （ P = 0. 027 ）. The sensitivity, specificity and accuracy of 3D-TOF-MRA were respectively 85.7% （30/35）, 71.4% （5/7） and 83.3% （35/42）. The differences between preoperative and postoperative blood pressures were not statistically significant in group A （P SBP = 0. 067, P DBP = 0. 184）, while they were statistically significant in group C （left side： P SBP 〈0.01, P DBP 〈 0. 01 ; right side： P SBP 〈 0.01, P DBP 〈 0. 01 ）. The differences of ABP （blood pressure change） （P △S
作者
彭里磊
明扬
陈义天
付洁
张苓
陆笑非
酉建
周杰
陈礼刚
Peng Lilei;Ming Yang;Chen Yitan;Fu Jie;Zhang Ling;Lu Xiaofei;You Jian;Zhou Jie;Chen Ligang(Department of Neurosurgery,the Affiliated Hospital of Southwest Medical University,Luzhou 646000,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2018年第9期931-936,共6页
Chinese Journal of Neurosurgery
关键词
高血压
神经外科手术
治疗结果
显微血管减压术
磁共振成像
Hypertension
Neurosurgical procedures
Treatment outcome
Microvascular decompression
Magnetic resonance imaging
