单导管消融改良肾交感神经治疗顽固性高血压的初步探讨  

Initial experience with single catheter ablation modified renal nervation for the treatment of hypertension

作　　者：卢春山[1,2] 郝蓬[1,2] 方冬平[1,2] 何东方[1,2] 张晓江[1,2] 刘梅颜[1,2] 吴小凡[1,2] 郭成军[1,2] 

机构地区：[1]首都医科大学附属北京安贞医院 [2]北京市心肺血管疾病研究所心内6病房,100029

出　　处：《心肺血管病杂志》2014年第4期525-528,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的：探讨以单导管消融改良肾交感神经治疗高血压疗效.方法：2011年11月至2013年10月期间,在本院因顽固性高血压行单导管消融改良肾交感神经治疗的30例患者（男性16例）.导管消融同步检测腹主动脉压力,以峰值压力降低20％ ～30％,来判断靶神经（肾交感神经）的消融效果.观察术前、术后1,3,6,12及18个月血压,并在术前、术后即刻及术后3个月行X线断层肾动脉成像（CTA）或肾动脉造影了解肾动脉情况.结果：患者术前平均诊室血压（160±15）/（95±10） mmHg（1mmHg=0.133kPa）,平均随访8个月,术后1,3,6,12及18个月,血压分别减低20/10mmHg、22/11 mmHg、25/10,mmHg、26/11 mmHg和28/17mmHg,与基础血压比较,差异有统计学意义（P＜0.05）.所有患者均未出现肾动脉狭窄,夹层,穿孔及其他严重并发症.结论：本组以单导管消融术改良肾交感神经,治疗顽固性高血压是行之有效且安全的,对于顽固性高血压患者具有比较显著且持久的降压作用.Objective：To evaluate the efficacy of single catheter ablation for modified renal nervation designed to reduce the duration of the intervention as well as to increase the consistency of the clinical outcome.Methods：Thirty consecutive patients suffering from treatment-resistant hypertention as defined by the （China 2010） guidelines were treated by transcatheter modified renal nervation using the single catheter.Office blood pressure measurements showed an immediate,significant and sustained decrease in blood pressure.Results：One,three,six,twelve,eighteen-month results were comparable to published data on raiofrequency modified renal nervation with an average reduction in office and home blood pressure of 20/10mmHg （1mmHg =0.133 kPa） 、22/11 mmHg 、25/10,mmHg、26/11 mmHg and 28/17mmHg,respectively （P ＜ 0.05）.Conclusion：Single catheter ablation appears to be a safe and effective treatment for hypertention and further studies will be performed to confirm these preliminary results.

关 键 词：高血压 肾交感神经改良 单导管消融 

分 类 号：R54[医药卫生—心血管疾病]