摘要
目的研究肾动脉支架置入术(percutaneoustransluminalrenalangioplastywithstent,PTRAS)对老年肾动脉粥样硬化性高血压的长期影响及临床相关因素。方法回顾性收集21例经肾动脉血管造影确诊并行PTRAS治疗的老年肾动脉粥样硬化性高血压患者的临床资料,分析长期血压水平及与疗效相关的临床因素。结果PTRAS使所有患者的血压改善,治疗当天患者的血压从治疗前的158.5/86.6mmHg下降至127.8/70.3mmHg(P<0.05),血压的改善维持至12个月,其中4例患者达2年以上。为控制血压所需的降压药物由PTRAS前的3.4种减少至当天1.5种(与PTRAS前比较P<0.05),随时间推移药物种类逐步增加至6个月时的(1.9±0.77)种,12个月时(1.9±0.81)种(与PTRAS当天比较P<0.05)。影响肾动脉粥样硬化性高血压疗效的因素分别是治疗前舒张压水平、肾动脉狭窄是否完全解除(即双侧肾动脉狭窄患者行单/双侧PTRAS)、外周血管病;而与年龄、治疗前收缩压、单侧或双侧肾动脉受累、患有慢性肾功能不全、高脂血症、糖尿病等无关。2例支架内再狭窄患者均出现血压升高。结论PTRAS能够有效改善老年人肾动脉粥样硬化性高血压并长期保持稳定,尽管6个月后为满意控制血压所需的降压药物种类增加。PTRAS后血压监测和降压药物的调整是应当重视的临床问题。
Objective To investigate the long-term effect of percutaneous transluminal renal artery stenting (PTRAS) on renal atherosclerosis hypertension and its related clinical factors.Methods Data of 21 elderly cases with renal atherosclerosis hypertension diagnosed by angiography and received PTRAS were retrospectively collected to analyze long-term blood pressure level and clinical factors related to therapeutic effect. Results 21 male aged 77.8±4.1 years old. Blood pressure of all patients were improved from 158.5/86.6 mmHg before PTRAS to 127.8/70.3 mmHg at the day after PTRAS (P<0.05), and remained till 12 months, among them 4 cases continued over 2 years. The kinds of antihypertensive drugs needed decreased from 3.4 before PTRAS to 1.5 right after PTRAS (P<0.05). However as times went by, the kinds of antihypertensive drugs increased to 1.9±0.77 at the 6th month and 1.9±0.81 at the 12th month(P<0.05). The factors related to therapeutic effect of renal atherosclerosis hypertension included diastolic pressure before treatment, complete relief of renal artery stenosis, peripheral vascular diseases; but the factors concerning age, systolic blood pressure before PTRAS, unilateral or bilateral stenosis, complicated with chronic renal dysfunction, hyperlipidemia or diabetes didn' t show any significance. Blood pressure of 2 patients with stenosis in stent again enhanced.Conclusions PTRAS could improve renal atherosclerosis hypertension of the most elderly and keep long-term stabilization, however the kinds of antihypertensive drugs needed for satisfactory blood pressure control should be increased after 6 month. The surveillance on blood pressure and adjust of antihypertensive drugs after PTRAS should be clinical issues being paid more attention to.
出处
《中国老年学杂志》
CAS
CSCD
北大核心
2005年第4期370-372,共3页
Chinese Journal of Gerontology
