摘要
目的评估支架置入重建血运治疗肾动脉狭窄的安全性与近中期临床疗效.方法 1999年至2003年,我院连续150例肾动脉严重狭窄的患者,其中男性93例(62.0%),女性57例(48.0%),年龄13～82岁,平均(52±19) 岁, 病因分别为动脉粥样硬化96例(64.0%)、大动脉炎44例(29.3%)和纤维肌性结构不良10例(6.7%),因严重高血压或伴有肾功能不全而进行了支架置入, 随诊6个月,观察手术对患者血压、肾功能的影响.结果 150例患者中,支架置入成功148例(98.7%),病变处管腔直径狭窄从65%～100%(85.5% ± 12.3%)降至0～25%(7.6%±5.2%),管腔最小直径从0～2.7 mm (1.6±0.9 mm)增至4.5～8.0 mm(6.0 ±1.1 mm).6个月随诊时, 患者血压明显下降(P<0.001), 收缩压从(169.6±32.5) mm Hg(1 mm Hg＝0.133 kPa)降至(142.7±28.1) mm Hg,舒张压从(97.3±17.8) mm Hg降至(83.3±15.2) mm Hg,服用降压药明显减少(从2.7种减至1.9种, P<0.001).其中48例(32.0%)治愈,78例(52.0%)改善, 22例(16.0%)无效.术后血肌酐改善34例(22.7%)、无变化112例(74.6%)及恶化4例(2.7%),总体上差异无统计学意义.肾动脉支架置入的手术并发症共12例(8%).6个月随诊期间无死亡.结论支架置入重建血运治疗肾动脉狭窄有较好的安全性和近中期疗效.
Objectives To evaluate the safety and midterm efficacy of stent revascularization as treatment for renal artery stenosis Methods Percutaneous transluminal renal angioplasty with stent (PTRA) was performed because of poorly controlled hypertension or preservation of renal function in 150 consecutive patients with severe renal artery stenosis, caused by atheroma (96 patients), arteritis (44 patients ) and fibromuscular displasia (10 patients) All of them subsequently underwent 6 month clinical follow up to observe the effect of the procedure on renal function, blood pressure control, number of antihypertensive medications Result Angiographic success was obtained in 148 (98 7%) of 150 patients after PTRA At 6 months, both systolic and diastolic blood pressures significantly decreased (from 169 6 to 142 7 mm Hg and from 97 3 to 83 3 mm Hg, respectively; P <0 001),and less antihypertensive medication was taken (from 2 7 to 1 9) The blood pressure became normal without taking any antihypertensive medications in 48 of 150 patients (32 0%), and the blood pressure control was more facile in 78 patients (52 0%), however, there were no improvement in 22 patients (16 0%) Creatinine level decreased in 34 patients (22 7%), remained stable in 112 patients (74 6%),and increased in 4(2 7%). There was no statistical significance No deaths ocurred during 6 months follow up Conclusions Renal artery stent revascularization had a beneficial effect on blood pressure control and a nondeleterious effect on renal function during 6 months follow up The long term efficacy should be investigated The procedure is safe in usual
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2005年第3期224-227,共4页
Chinese Journal of Cardiology
