5F射频消融导管在经皮肾动脉交感神经消融术中的安全性和有效性研究  

Safety and efficacy evaluation of catheter-based renal denervation by 5F radiofrequency ablation catheter

作　　者：徐佑龙[1] 谢赟[2] 郜俊清[1] 严鹏勇[1] 张文全[1] 孙剑光[1] 王明喻[1] 金惠根[1] 刘宗军[1] 

机构地区：[1]上海中医药大学附属普陀医院心内科,上海200062 [2]上海市普陀区人民医院

出　　处：《中国介入心脏病学杂志》2013年第2期112-116,共5页Chinese Journal of Interventional Cardiology

基　　金：上海市医学重点专科建设项目(05Ⅱ026)

摘　　要：目的研究5F射频消融导管在经皮肾动脉交感神经消融术(catheter-based renal denervation,RDN)中的安全性和有效性。方法 8只实验用小型猪随机分为两组(温控消融组、非温控消融组)。使用6FJR导引导管行左右肾动脉造影。以7F导引导管作为指引,置入5F射频消融导管,在左右肾动脉行RDN术(非温控模式组:8W,温控模式组:50°;均采用螺旋式消融,每个点消融60～90s,左右肾动脉各消融4～6个点,相邻消融点间隔0.5cm)。所有动物于术前、消融术后2周行肾动脉、肾静脉、外周静脉取血,采集并评估血指标(包括去甲肾上腺素、肾上腺素、肾素、醛固酮等)。结果 RDN术前后,所用实验用小型猪心率、血压、肾功能均无明显改变。消融术后2周随访血指标,无论是非温控消融还是温控消融,均可以显著抑制小型猪RAAS系统和交感神经系统的活性(非温控组RDN术前后各血指标比较:肾素P=0.005,醛固酮P=0.053,去甲肾上腺素P<0.001,肾上腺素P=0.031;温控组RDN术前后各血指标比较:肾素P=0.008,醛固酮P<0.001,去甲肾上腺素P=0.429,肾上腺素P=0.017)。结论 5F射频消融导管可以作为一种消融导管应用于经皮肾动脉交感神经消融术(动物例数较少,仍需大规模实验验证)。Objective To study the safety and effects of catheter-based renal denervation （RDN） by 5 F radiofrequeney ablation catheter. Methods 8 experimental miniature swine were randomly divided into two groups （temperature-controlled ablation group and non-temperature-controlled ablation group）. The 6 F JR guiding eatheter was used in renal arteriography. In the RDN, 7F guiding catheter was used as a guide, placed 5F RF ablation catheter in the bilateral renal artery （non Thermostat Mode group： 8 W, Thermostat Mode group： 50 ~, 60 -90 seconds, 4 -6 points, adjacent the ablation point intervals 0. 5 era）. Blood samples were collected from renal artery, renal vein, peripheral veins before and 2 weeks after the RDN for measurements of norepinephrine, epinephrine, renin and aldosterone）. Results Before and 2 weeks after the RDN, no changes were observed in heart rate, blood pressure and renal function. Two weeks after RDN, the results showed that follow-up regardless of the non-temperature-controlled ablation or thermostat ablation, the RAAS system and the activity of the sympathetic nervous system were suppressed significantly. In the non-temperature controlled group, levels between pre-RDN and 2 weeks after were： aldosterone （559 ng/L vs. 258 ng/L, P = 0. 053 ）, norepinephrine [ （ 285.5 ± 50. 9 ） ng/L vs. （ 207.8 ± 82. 3 ） ng/L, P 〈 0. 001 ], epinephrine [ （494. 1 ± 144. 7） ng/L vs. （313.4 ± 113.2） ng/L, P = 0. 031 ] and renin （432 ng/L vs. 276 ng/L, P =0. 005 ）. And in the temperature controlled group, the levels between pre-RDN and 2 weeks later： aldosterone （328 ng/L vs. 79 ng/L, P =0. 001）, norepinephrine （279 ng/L vs. 195 ng/L, P=0.075）, epinephrine （336 ng/L vs. 125 ng/L, P=0.001） and renin （203 ng/L vs. 115 ng/L, P--0. 013）. Conclusions The 5F radiofrequency ablation catheter can be safely and effectively used in the RDN as the ablation catheter.

关 键 词：肾动脉 交感神经切除术 导管消融 射频 高血压 

分 类 号：R541.61[医药卫生—心血管疾病]