经皮射频消融肾动脉去交感神经术治疗顽固高血压的安全性和护理经验  

Safety and nursing experience of percutaneous radiofrequency ablation of renal artery denervation surgery in the treatment of refractory hypertension

作　　者：周建军[1] 卢春山[1] 刘梅颜[1] 郭成军[1] 

机构地区：[1]首都医科大学附属北京安贞医院心内六科,100029

出　　处：《中华心脏与心律电子杂志》2015年第1期39-41,共3页Chinese Journal of Heart and Heart Rhythm(Electronic Edition)

摘　　要：目的探讨导管消融肾动脉去交感神经术治疗顽固性高血压的护理经验。方法2011年10月至2013年6月我科收治顽固性高血压30例，其中男16例，女14例，在局麻下行经导管射频消融去肾交感神经术治疗，术前做好血压、肾功能等指标参数监测以及心理疏导；术中密切监测生命体征变化，并做好导管消融过程中患者疼痛护理；术后注意观察穿刺部位，有无出血情况，血压变化和尿量及肾功能相关生化指标。术前术后血压比较采用配对t检验。结果患者术前平均诊室血压160±15／95±10mmHg。平均随访（8±5）个月，术后1、3、6、12、18个月时血压有不同程度的下降，血压分别下降20／10mmHg、22／11mmHg、25／10mmHg、26／11mmHg和28／17mmHg，术后的血压与术前血压比较差异有统计学意义（P〈0．05）。1例患者术后护理中发现肾动脉轻度狭窄，术后1个月复查狭窄消失，3例患者射频治疗过程中有一过性心动过缓伴血压下降，1例患者股动脉穿刺部位出现血肿。无任何须住院治疗的低血压事件。结论积极的手术前后的护理配合是保证消融’肾动脉去交感神经治疗顽固性高血压手术顺利完成的基本条件之一。Objective To explore the nursing experience of catheter ablation of renal artery sympathetic denervation in patients with refractory hypertension. Methods Thirty consecutive patients suffering from treatment-resistant hypertention as defined by the guidelines were treated by transcatheter modified renal nervation using the single catheter. Blood pressure measurements showed an immediate, significant and sustained decrease in blood pressure. Under local anesthesia catheter ablation of renal denervation were performed. Blood pressure, renal function and other parameters monitoring and psychological counseling, skin preparation were done before operation; Vital signs monitoring, and pain nursing were observed during ablation process; Puncture site bleeding, urine volume and renal function, blood pressure related biochemical indexes were monitored after operation. 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 20/10 mmHg. 22/11 mmHg. 25/10 mmHg. 26/11 mmHg and 28/17mmHg,respectively（ P 〈 O. 05 ）. One patient developed mild stenosis of renal artery, and the stenosis was disappeared one month later,three patients had bradycardia associated with a drop in blood pressure RF treatment process, One patient with femoral artery puncture site hematoma and none with any inpatient treatment of hypotension event. Conclusion Catheter ablation appears to be a safe and effective treatment for hypertention . Preoperative and postoperative nursing can guarantee the positive operation and obtain ideal curative effect.

关 键 词：高血压 肾动脉去交感神经术 护理 

分 类 号：R544.1[医药卫生—心血管疾病]