经皮肾动脉支架术治疗老年动脉粥样硬化性肾动脉狭窄患者的疗效  

Clinical efficacy of renal artery stent as treatment for atherosclerotic renal artery stenosis in elderly patients

作　　者：杨倩[1] 蒋雄京[1] 杨跃进[1] 吴海英[1] 张慧敏[1] 惠汝太 徐波[1] 高润霖[1] 

机构地区：[1]北京协和医学院中国医学科学院阜外心血管病医院心血管内科,100037

出　　处：《中华老年医学杂志》2009年第5期366-370,共5页Chinese Journal of Geriatrics

基　　金：国家“十五”科技攻关项目子课题（2004BA720A29）

摘　　要：目的评估肾动脉支架置入治疗老年严重动脉粥样硬化性肾动脉狭窄患者的安全性和临床疗效。方法我们于2003年1月至2008年4月进行了一项前瞻性非随机研究，连续147例动脉粥样硬化性肾动脉严重狭窄的老年患者，其中男性106例，女性41例，肾动脉狭窄直径≥65％，因严重高血压或伴有肾功能不全而进行肾动脉支架术，随诊6～66个月，观察手术对患者肾功能、血压、心脑血管事件的影响。结果147例患者经皮肾动脉支架置入均成功。与术前基线值比较，血压随访时显著下降（P〈0．01），并且服药种数减少（P〈0．01）。血清肌酐在6～48个月随访时下降（P〈0．05），54～66个月时差异无统计学意义（P〉0．05）；血尿素在6～24个月随访时下降（P〈0．05），30～66个月时差异无统计学意义（P〉0．05）。经皮肾动脉支架置入操作相关并发症共7例（4．8％）。失访17例（11．6%），发生心脑血管事件18例（12．2％），包括肾脏事件4例（2．7％）、心肌梗死4例（2．7％）、脑卒中2例（1．4％）和心脑血管死亡8例（5．4％）。术后第1、2、3、4、5年的无事件生存率分别为91．0％（121/133）、90．2％（83／92）、78．5％（51／65）、73．8%（31／42）、54．8％（17／31），生存率分别为94．0％（125／133）、90．2％（83／92）、84．6％（55／65）、73．8％（31／42）、61．3％（19／31）。结论经皮肾动脉支架置入治疗老年动脉粥样硬化性肾动脉严重狭窄有较高的安全性、中远期降血压和稳定肾功能获益。表明肾动脉支架术有可能减少心脑血管事件的发生率并降低病死率。Objective To evaluate the safety and clinical efficacy of renal artery stent treatment for severe atherosclerotic renal artery stenosis （ARAS） in the elderly. Methods In a prospective nonrandomized study in our hospital from January 2003 to April 2008, 147 consecutive elderly patients with ARAS （diameter reduetion≥65%） underwent percutaneous transluminal renal angioplasty and stenting （PTRAS） for resistant hypertension or reserving renal function. They were followed up for 6- 66 months and the effects of the procedure on renal function, blood pressure and cardiovascular events were observed. Results The success rate of PTRAS was 100%. During 6-66 months of follow up, both systolic and diastolic blood pressure were significantly decreased, and less antihypertensive medication was taken （P〈0.01）. Serum creatinine was significantly decreased during 6-48 months of follow up （P〈0.05） and did not change significantly during 54-66 months of follow up （P〉0.05）. Blood urea nitrogen was significantly decreased during 6-24 months of follow up （P〈0.05） and did not change significantly during 30-66 months of follow up （P〉0.05）. Complications related with the procedure occurred in 7 cases （4.8%）. 17 patients failed to follow up （11.6%） and in 18 cases cardiovascular events occurred （12.2%）, including 4 cases of renal events （2.7%）, 4 cases of myocardial infarction （2.7%）, 2 cases of stroke （1.4%） and 8 cases of cerebral and cardiovascular events （5.4%） during 6-66 months of follow up. The survival rates of free of events at year 1, 2, 3,4 and 5 were 91.0%（121/133）, 90.2%（83/92）, 78.5%（51/65）, 73.8% （31/42） and 54.8% （17/ 31）, respectively. The survival rates at year 1, 2, 3, 4 and 5 were 94.0%（125/133）, 90.2%（83/ 92）, 84.6%（55/65）, 73.8%（31/42） and 61.3%（19/31）, respectively. Conclusions Renal artery stent as treatment for ARAS in the elderly has a beneficial effect on blood pressure control and on renal function dur

关 键 词：肾动脉梗阻 支架 高血压 

分 类 号：R686[医药卫生—骨科学]