经皮肾去交感神经术治疗老年难治性高血压患者的临床研究  

Percutaneous renal sympathetic denervation for elderly refractory hypertension patients

作　　者：盛晓东[1] 金骁琦[1] 朱宗成[1] 

机构地区：[1]常熟市第二人民医院心血管内科,215500

出　　处：《中华老年心脑血管病杂志》2014年第6期592-595,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：江苏省卫生厅基金项目(YG201308)

摘　　要：目的对老年难治性高血压患者行经皮肾去交感神经术(RSD),观察其有效性、安全性及可行性。方法选择连续难治性老年高血压患者20例,行经皮RSD,观察术前和术后1、3、6个月随访时的诊室血压变化;术前和术后动态血压、血清肌酐、估算的肾小球滤过率、肾素活性、血管紧张素Ⅱ和醛固酮变化;手术并发症发生情况。结果与RSD前比较,患者RSD后1、3、6个月随访时诊室血压分别下降了16.9/11.9、24.8/17.1、29.1/20.5mm Hg(1mm Hg=0.133kPa,P<0.01),术后动态血压下降了24.2/17.2mm Hg(P<0.01),肌酐和估算的肾小球滤过率无显著变化(P>0.05),肾素活性、血管紧张素Ⅱ和醛固酮显著下降(P<0.05);1例患者发生股动脉血肿。结论对老年高血压患者行经皮RSD可能安全、有效、可行。Objective To assess the efficiency ,safety and feasibility of percutaneous renal sympathetic denervation （RSD） for elderly refractory hypertension patients .Methods Office and ambulatory blood pressures ,serum levels of creatinine ,angiotensin Ⅱ and aldosterone ,estimated glomerular filtration rate （eGFR） and rennin activity were measured in 20 elderly refractory hypertension patients before and 1 ,3 ,6 months after percutaneous RSD .Complications of percutaneous RSD were observed .Results The office and ambulatory blood pressures were 16 .9/11 .9 mm Hg （1 mm Hg=0 .133 kPa） ,24 .8/17 .1 mm Hg ,29 .1/20 .5 mmHg and 24 .2/17 .2 mm Hg lower 1 , 3 ,6 months after percutaneous RSD than before percutaneous RSD （ P〈 0 .01 ） .No significant difference was found in serum creatinine level and eGFR before and after percutaneous RSD （P〉0 .05） .The creatinine ,angiotensin Ⅱand aldosterone levels were significantly lower after percutaneous RSD than before percutaneous RSD （P〈0 .05） .Femoral artery hematoma was detected in 1 patient .Conclusion Percutaneous RSD is a safe ,effective and feasible procedure for elderly refractory hypertension patients .

关 键 词：高血压 交感神经切除术 肾小球滤过率 血管紧张素Ⅱ 醛固酮 导管消融术 ANGIOTENSIN Ⅱ 

分 类 号：R544.1[医药卫生—心血管疾病]