经皮肾动脉交感神经消融术中消融点位对顽固性高血压患者降压效果的影响  

Effect of ablation sites in catheter-based renal sympathetic denervation on anti-hypertension results in patients with resistant hypertension

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

出　　处：《第二军医大学学报》2014年第2期191-194,共4页Academic Journal of Second Military Medical University

基　　金：上海市医学重点专科建设项目(05Ⅱ026)~~

摘　　要：目的 探索不同消融位点对经皮肾动脉交感神经消融术治疗顽固性高血压降压效果的影响.方法 选择16例顽固性高血压患者,随机分为近中段消融组和全段消融组,每组8例.完善相关检查后行经皮肾动脉交感神经消融术治疗.术中记录消融参数（起始阻抗值、最低阻抗值、消融实际功率、消融实际温度）,术后即刻复查肾动脉造影.所有患者术后继续监测血压,随访至术后3个月.结果 全部16例患者均成功完成经皮肾动脉交感神经消融术.所有患者消融起始阻抗平均值为（180.0±12.3）Ω,消融最低阻抗平均值为（157.8±12.8）Ω,阻抗下降率平均为（12.4±2.6）％;实际消融温度为40～50℃,功率为5～18 W.术后肾动脉造影显示全段消融组2例发生肾动脉痉挛,近中段消融组无一例发生肾动脉痉挛,两组肾动脉痉挛发生率差异无统计学意义（P=0.08）.术后3个月随访,两组患者血压未见明显差异.结论 在肾动脉近中段进行消融,特别是在肾动脉开口处消融,可能不会影响经皮肾动脉交感神经消融术的降压效果,并可一定程度上减少肾动脉狭窄的发生率.Objective To study the effects of ablation site in catheter based renal sympathetic denervation （RDN） on antihypertensive results in patients with resistant hypertension. Methods A total of 16 patients with resistant hypertension were evenly randomized into two groups： proximal or distal ablation group. RDN was performed after examination. The ablation parameters , including impedance starting value, minimum impedance, actual wattage, and the actual temperature, were recorded intraoperatively. Renal angiography was done again immediately after RDN. Standardized BP measurements were obtained in all patients for 3 months after operation. Results All the 18 patients underwent RDN successfully. The average initial impedance of the 18 patients was （180.0±12.3） Ω, average minimum impedance was （157.8±12. 8） Ω, and average impedance drop rate was （12.4±2.8） Ω. The actual ablation temperature was 40 50℃, with the actural ablation wattage being 5 18 W. The renal angiography showed two cases of renal artery spasm in the distal ablation group and none in the proximal group, with no significant difference found in the incidence between the two groups （P=0. 08）. There was no significant difference in BP between the two groups 3 months after RDN. Concision Proximal ablation, particularly at the opening of renal artery, may not influence the antihypertensive effect of RDN, and to some extent it can reduce the incidence of renal artery stricture.

关 键 词：经皮肾动脉交感神经消融术 消融位点 顽固性高血压 

分 类 号：R544.1[医药卫生—心血管疾病]