手术治疗动脉硬化性肾动脉狭窄围手术期高血压及肾功能变化的研究  

Perioperation outcome of hypertension and renal function after renal arterial revascularization for atherosclerotic renal artery stenosis

作　　者：周游[1] 陈兵[1] 俞恒锡[1] 李建新[1] 谷涌泉[1] 齐一侠[1] 罗涛[1] 郭连瑞[1] 杨盛家[1] 张建[1] 

机构地区：[1]首都医科大学宣武医院血管外科,北京100053

出　　处：《中华临床医师杂志（电子版）》2011年第24期7196-7201,共6页Chinese Journal of Clinicians(Electronic Edition)

基　　金：首都医学发展科研基金(2009-2088)

摘　　要：目的对动脉硬化性肾动脉狭窄(ARAS)患者围手术期高血压及肾功能病情变化进行总结,判断外科和介入技术的治疗疗效。方法 2006年8月至2010年5月共80例肾动脉狭窄患者(共108条肾动脉病变)为研究对象,男女比例为1.8∶1,平均年龄(64.8±11.1)岁,经选择性肾动脉造影确诊肾动脉狭窄及狭窄程度,其中单侧病变52例,双侧病变28例,肾动脉轻中度狭窄(50%～69%)20条,重度狭窄(70%～99%)82条,肾动脉闭塞6条。行支架成形术67例71条肾动脉,单纯球囊成形术3例5条肾动脉,开放手术3例3条肾动脉,药物治疗7例9条肾动脉。结果全部手术治疗均顺利完成,总体肾功能获益率38.4%,高血压治疗有效率73.9%。术前血压(152.93±23.61)/(80.17±13.85)mm Hg,术后血压(134.76±16.42)/(71.53±13.85)mm Hg,差异有统计学意义(P=0.000),对比肌酐、尿素氮、肾小球滤过率及口服降压药种类,术前、术后差异无统计学意义。对比双侧ARAS解除一侧狭窄与单侧ARAS解除狭窄后一周疗效,肾小球滤过率差异有统计学意义(P=0.038)。结论外科和介入技术对改善ARAS患者高血压具有较明确的意义;双侧ARAS患者单侧治疗后肾小球滤过增加优于单侧ARAS患者,说明外科和介入治疗对维持肾功能有益。Objective To explore the effect of the surgical treatment for preoperative period outcome of hypertension and renal function in atherosclerotic renal artery stenosis(ARAS) patients.Methods 80 patients with 108 stenotic renal arteries in total between August 2006 and May 2010 were retrospectively analyzed.The sex ratio(M/F) was 1.8∶1 and average age was (64.8±11.1) years old.The renal artery stenosis was confirmed by renal artery angiography.Fifty-two patients suffered unilateral ARAS and 28 patients suffered bilateral ARAS,including 20 mild-mid range stenotic renal arteries,82 severe ones and 6 occlusive ones.Renal artery stenting treatment were performed in 67 patients,angioplasty treatment in 3 and 3 underwent traditional surgical operation.The other 7 patients were treated by medication.Results All the surgical treatments were performed successfully with 38.4% cases renal function improvement and 73.9% cases improved for hypertension.The post-operative blood pressures were improved with a statistical significance(P=0.000).Meanwhile,there were no significant differences for blood creatinine,blood urea nitrogen,glomerular filtration rate (GFR) before and after the operation.A significant difference was found between bilateral and unilateral ARAS patients for their GRFs improvement(P=0.038).Conclusions The surgical treatment can effectively help to relieve the conditions of hypertension from ARAS.For the reservation of renal functions,the bilateral ARAS patients undergoing oneside treatment seemed to benefit more from the operation than unilateral ARAS patients.

关 键 词：肾动脉梗阻 高血压 肾小球滤过率 肾动脉支架成形术 

分 类 号：R699[医药卫生—泌尿科学]