经皮肾动脉交感神经消融术对难治性高血压患者术后即刻肾动脉直径的影响  

Evaluation of the renal artery diameter immediately after renal sympathetic denervation 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] 王明瑜[1] 桑震池[1] 陈晨[1] 徐三彬[1] 刘兴华[1] 杨伟[1] 汪志华[1] 汪蔚青[1] 王大英[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》2015年第8期862-866,共5页Academic Journal of Second Military Medical University

基　　金：上海市卫计委重点项目(20134003);上海市普陀区卫生系统自主创新科研资助项目~~

摘　　要：目的探索经皮肾动脉交感神经消融术(RDN)对难治性高血压患者术后即刻肾动脉直径的影响。方法入选难治性高血压患者,所有患者在术前、术后即刻使用定量冠状动脉造影技术(QCA)进行肾动脉直径的测量并记录数值,术中记录阻抗起始值、阻抗最低值、消融点位、消融功率等消融参数指标。所有患者于RDN术前、术后6个月检测动态血压。结果共12例符合标准的难治性高血压患者入选了本研究,平均入院动态血压为(185±15)/(99±9)mmHg(1mmHg=0.133kPa)。在RDN术后6个月,动态血压平均值下降31/15mmHg,与术前相比差异有统计学意义(P<0.001)。所有患者的肾动脉直径在消融术后即刻均出现扩张,肾动脉直径平均值增加0.6mm,与术前相比差异有统计学意义(P<0.001)。消融阻抗下降值与肾动脉术后即刻直径相关(r=0.74,P=0.006),但患者术后肾动脉直径扩张程度并不能预测术后血压的变化(P>0.05)。所有患者均未发生任何外周血管并发症。结论 RDN术可降低难治性高血压患者的动态血压水平,并可在术后即刻扩张肾动脉直径,肾动脉直径的扩张程度和消融阻抗的下降值正相关,但肾动脉直径的扩张程度无法预测患者的远期血压水平。Objective To explore the renal artery diameter immediately after the renal sympathetic denervation（RDN）in patients with resistant hypertension.Methods Patients with resistant hypertension were enrolled in this study,and all patients were measured and recorded for the renal artery diameter values using the quantitative coronary angiography（QCA）before and immediately after the RDN.All the ablation parameters including starting impedance,terminal impedance,ablation power,and ablation point were recorded.Ambulatory blood pressure（BP）measurement was performed at the baseline and 6months after RDN.Results A total of 12 patients with resistant hypertension were finally enrolled in this study.The mean ambulatory BP of the patients was（185±15）/（99±9）mmHg（1mmHg=0.133kPa）at admission,which was decreased by 31/15 mmHg in 6months after RDN,showing significant difference compared with before RDN（P0.001）.The dilation of renal artery diameter was observed in all patients immediately after the RDN,with the mean renal artery diameter increased by 0.6mm,also showing significant difference compared with before RDN（P0.001）.It was found that the renal artery diameter was correlated with the decrease of ablation impedance（the correlation coefficient = 0.74,P=0.006）.However,the degree of renal artery diameter dilation could not predict the changes of BP after RDN（P0.05）.No peripheral vascular complications occurred in these patients.Conclusion RDN can significantly reduce the ambulatory BP in patients with resistant hypertension,and expand the renal artery diameter immediately.The degree of renal artery diameter dilation is positively correlated with the ablation impedance decrease,but it can not predict the long-term BP in patients.

关 键 词：经皮肾动脉交感神经消融术 肾动脉直径 难治性高血压 

分 类 号：R544.1[医药卫生—心血管疾病]