摘要
目的探讨经皮导管肾交感神经射频消融术（renal sympathetic denervation，RSD）治疗顽固性高血压的有效性和安全性。方法对32例顽固性高血压患者实施RSD，随访12个月。比较RSD术前与RSD术后第3、6及12个月的血压下降水平、肾功能变化情况以及降压药使用情况；术后行计算机断层扫描（computed tomography，CT）检查。肾动脉有无异常。结果32例患者中，RSD术后第3个月失访1例，术后第6个月失访2例，其余29例患者完成术后12个月的随访。RSD术后第3个月时，患者收缩压和舒张压分别下降为[（18．5±3．6）mmHg，（P〈0．01）]和[（5．8±2．5）mmHg，（P〈0．01）]；RSD术后第6个月时，患者收缩压和舒张压分别下降[（24．3±2．2）mmHg，（P〈0．01）]和[（8．7±2．6）mmHg，（P〈0．01）]；RSD术后第12个月时，患者收缩压和舒张压分别下降[（20．7±3．2）mmHg，（P〈0．01）]和[（6．6±1．8）mmHg，（P〈0．01）]。术后未见严重低血压及并发症出现。在RSD术后第3、6及12个月时，患者合并使用降压药的种类较RSD术前有明显减少[第3、6及12个月时分别减少43．7％（P〈0．01）、41．9％（P〈0．01）和44．8％（P〈0．01）]；与RSD术前比较，RSD术后第3、6及12个月时，检测估算肾小球滤过率（estimate glomerular filtration rate，eGFR）水平、血肌酐水平、血清胱抑素C水平均无明显变化（P〉0．05）；而心率水平在RSD术后第3、6及12个月时均比RSD术前有明显下降（P〈0．05）。术后随访未见肾动脉以及肾功能异常。结论RSD对治疗顽固性高血压有一定的有效性和安全性，且介入方法简单，值得在临床上推广应用。
Objective To investigate the safety and efficacy of catheter-based renal sympathetic denervation （RSD） in the treatment of resistant hypertension. Methods Thirty-two patients with re- sistant hypertension were treated with RSD and followed up for 12 months. Blood pressure, renal function and total dosages of antihypertensive medications were recorded respectively and compared be- fore and after the procedure at 3rd, 6th and 12th month. CT scan was scheduled to observe renal ar- tery during the follow-up period. Results At 3rd month after RSD, the systolic and diastolic blood pressure was （18. 5±3. 6） mm Hg （P〈0. 01） and （5.8± 2. 5） mm Hg （P〈0. 01） respectively, sig- nificantly lower than that of the procedure before RSD. Similarly, the systolic and diastolic blood pres- sure at 6th month after RSD was （24. 3± 2. 2） mm Hg （P〈0. 01） and （8. 7 ± 2. 6） mm Hg （P〈0. 01）, which was decreased as compared with that before RSD respectively; Furthermore, at 12th month after RSD the systolic and diastolic blood pressure was （20. 7 ± 3. 2） mm Hg （P〈0. 01） and （6. 6 1.8） mm Hg （P〈0. 01）, which was decreased as compared with that before RSD respectively. There no severe hypotension and complications. During the follow-up period of 3, 6 and 12 months, the categories of antihypertensive medications used were significantly reduced by 43.7% （P〈0. 01）, 41.9% （P〈0. 01） and 44. 8% （P〈0. 01） respectively as compared with those before RSD. The eG-FR, creatinine and cystatin levels showed no significant change before and 3, 6, 12 months after RSD （P〉0. 05）. At 3rd, 6th, and 12th month after RSD, the heart rate was significantly decreased as compared with that before RND （P〈0.05）. No abnormality of renal artery and renal function was ob- served after the procedure of RND. Conclusions RSD is a relatively simple, safe and effective inter- ventional therapy to treat resistant hypertensiorL It deserves promotion in clinical practice.
出处
《临床肾脏病杂志》
2015年第1期25-29,共5页
Journal Of Clinical Nephrology
基金
武汉市卫生局临床医学科研项目(WX13C32)
关键词
导管消融术
去肾交感神经
高血压
顽固性
心血管疾病
Catheter ablation
Renal sympathetic denervation
Resistant hypertension
Cardio-vascular disease
Clinical application
