肾动脉狭窄所致的一过性肺水肿与左室舒张功能不全的鉴别  

Flash pulmonary edema caused by renal artery stenosis misdiagnosised as left ventricule dystolic dysfunction

作　　者：时向民[1] 陈练[1] 任艺虹[1] 董蔚[1] 王玉堂[1] 盖鲁粤[1] 

机构地区：[1]解放军总医院心内科,北京100853

出　　处：《临床心血管病杂志》2006年第3期151-153,共3页Journal of Clinical Cardiology

摘　　要：目的：探讨肾动脉狭窄导致一过性肺水肿的临床特点，分析其与左室舒张功能不全的鉴别要点。方法：回顾分析2002年5月～2004年5月住院的难治性高血压并发夜间阵发性呼吸困难的患者12例，造影显示单侧或双侧肾动脉狭窄超过50％，肾动脉球囊扩张及支架置入后随访6个月观察临床症状、血压、肾功能的变化。结果：单侧及双侧肾动脉狭窄各6例，7例患者伴有肾功能不全，5例肾功能正常但肌酐清除率＜80ml／min。5例患者伴有低血钾（〈3．5mmol／L），夜间阵发性呼吸困难发作突然，利尿剂治疗效果好。肾动脉支架置入后3个月血压较治疗前明显降低（P〈0．05），7例肾功能不全患者血肌酐降低[（121．5±28．4）μmol／L：（166．4±46．3）μmol／L（P〈0．05）]，血钾恢复正常，所有患者夜间阵发性呼吸困难消失。结论：难治性高血压突发夜问阵发性呼吸困难，同时并发肾功能不全、低血钾、利尿剂治疗效果佳，应高度提示肾动脉狭窄导致的肺水肿，而非单纯左室舒张功能不全。Objective： To investigate clinical character of flash pulmonary edema caused by renal artery stenosis and analysis what are the key points to differentiate it from diastolic dysfunction of left ventricule. Method： Twelve patients with refractory hypertension and paroxysmal nocturnal dyspnea hospitalized from 2002.5 to 2004.5 were retrospectively analyzed, Angiography indicated unilateral or bilateral renal artery stenosis above 50 percents. Patients were followed up 3 months after renal artery angioplasty and stent implantation. Clinical symptom, blood pressure and renal function were evaluated. Result： Seven patients complicated renal insufficient, 5 patients with normal renal function but with creatinine clearence rate less than 80 ml/min, 5 patients were found hypopotassemia and nocturnal dyspnea happened and could be effectively relieved by diuretic. 3 months after renal artery stent implantation, blood pressure was significantly decreased （146.8±17.6）/（82.2±13.7）mmHg vs （179.3±25.4）/（90.5±11.6）mmHg （P 〈 0.05）, and renal function was improved in 7 patients with serum creatine decreased （121.5±28.4）μmol/L ： （166.4±46.3）μmol/L （P 〈 0.05）, electrolyte was normal and paroxymal nocturnal dyspnea disappeared in all patients. Conclusion： Patients with refractory hypertension with paroxysmal noctural dyspnea should suspect flash pulmonary edema caused by renal artery stenosis rather than simple left ventricle dystolic dysfunction, especially when patients complicated renal insufficient and hypopotassemia.

关 键 词：高血压 肾血管性 肾动脉狭窄 肺水肿 左室舒张功能不全 

分 类 号：R541.7[医药卫生—心血管疾病]