肾动脉近段与全段交感神经去除术对顽固性高血压降压疗效的比较  

The comparison of two different renal denervation strategies on blood pressure in resistant hypertension

作　　者：陈伟杰[1] 张波[1] 凌智瑜[1] 李芝峰[2] 苏立[1] 宋文信 刘增长[1] 杜华安[1] 袁跃龙 邵江[5] 张建红 钟斌[7] 李承治[1] 鄢学 徐燕萍[1] 肖培林[1] 范晋奇[1] 殷跃辉[1] 

机构地区：[1]重庆医科大学附属第二医院心内科,重庆400010 [2]重庆医科大学附属永川医院心内科 [3]重庆市大足区人民医院心内科 [4]重庆市永川区人民医院心内科 [5]重庆三峡中心医院心内科 [6]重庆市铜梁中医院心内科 [7]重庆市第五人民医院心内科

出　　处：《临床心血管病杂志》2015年第10期1091-1095,共5页Journal of Clinical Cardiology

摘　　要：目的:探究肾动脉近段交感神经去除术(肾动脉消融)治疗顽固性高血压的有效性和安全性。方法:40例顽固性高血压患者为研究对象,并随机分为全段消融组(全段组,21例)和近段消融组(近段组,19例)。采用单极盐水灌注导管进行消融。随访至术后6个月,所有患者定期测量诊室血压,部分患者术前、术后6个月监测24h动态血压。结果:与全段组相比,近段组左侧[(6±1)︰(3±0),P<0.01]及右侧[(7±1)︰(3.2±0.2),P<0.01]肾动脉消融位点数目均有减少。近段组总消融时间短于全段组[(331±32)s︰(906±130)s,P<0.01]。全段组与近段组基线诊室血压分别为(178.0±13.5/101.7±9.1)mmHg与(179.8±10.8/103.9±9.0)mmHg(收缩压和舒张压均P>0.05),术后6个月全段组与近段组诊室血压分别下降(-37.7±10.4/-20.4±7.3)mmHg和(-39.5±9.2/-21.9±8.2)mmHg(收缩压和舒张压均P>0.05)。两组各有14例患者在术前、术后6个月监测24h动态血压,结果显示白天平均血压下降值低于诊室平均血压下降值[(-23.3±11.6/-14.2±6.2)mmHg︰(-37.7±19.4/-20.4±7.3+mmHg,收缩压和舒张压均P<0.001]。未发现消融相关血管并发症。结论:对顽固性高血压肾动脉近段消融与全段消融有相似的效果及安全性。Objective：To evaluate the efficacy and safety of proximal renal denervation（RDN）in patients with resistant hypertension.Method：Forty patients with resistant hypertension were randomly divided into two groups：full-length ablation group（n=21）and proximal ablation group（n=19）.All lesions were created with radiofrequency energy by a saline-irrigated,unipolar catheter.Office and 24 hblood pressure（BP）monitoring were measured preoperatively and during 6months of follow up.Result：Compared with full-length ablation group,the number of ablation sites of proximal ablation group declined in both the right[（7±1）vs.（3.2±0.2）,P〈0.01]and left renal arteries[（6±1）vs.（3±0）,P〈0.01].The total ablative time was significantly reduced in proximal group[（331±32）s vs.（906±130）s,P〈0.01].Baseline office BPs were（178.0±13.5/101.7±9.1）mmHg in full-length group and（179.8±10.8/103.3±9.0）mmHg in proximal group（P〉0.05 for both systolic and diastolic BP）.Office BPs were reduced by（-37.7±10.4/-20.4±7.3）mmHg in full-length group and（-39.5±9.2/-21.9±8.2）mmHg at 6month（P〉0.05 for both systolic and diastolic BP）.In a subgroup of 14 patients from each group that had ambulatory BP measured before and after 6months of RDN,the drop in mean daytime BP was less than the drop in office BP [（-23.3±11.6/-14.2±6.2）mmHg vs.（-37.7±19.4/-20.4±7.3）mmHg,P〈0.001 for both systolic and diastolic BP].No ablation-related renovascular complications were observed on renal artery CTA.Conclusion：The results indicate proximal RDN has a similar safety and efficacy profile compared with full-length RDN.

关 键 词：肾动脉消融 顽固性高血压 全段消融 近段消融 

分 类 号：R544.1[医药卫生—心血管疾病]