单中心肾动脉粥样硬化性狭窄行经皮肾动脉支架术治疗疗效分析  

Patients with atherosclerotic renal artery stenosis treated with percutaneous transluminal renal artery stenting for clinical efficacy in a single center

作　　者：周铁楠[1] 苑文杰[1] 王效增[1] 刘丽稳 韩雅玲[1] 荆全民[1] 赵昕[1] ZHOU Tie-nan YUAN Wen-jie WANG Xiao-zeng LIU Li-wen HAN Ya-ling JING Quan-min ZHAO Xin(Department of Cardiology, The General Hospital of Shenyang Military Command,Shenyang 110016,China)

机构地区：[1]沈阳军区总医院心血管内科,辽宁沈阳110016

出　　处：《临床军医杂志》2016年第11期1135-1139,1143,共6页Clinical Journal of Medical Officers

摘　　要：目的探讨肾动脉粥样硬化性狭窄(ARAS)患者行经皮肾动脉支架术(PTRAS)的安全性及临床疗效。方法回顾性分析1998年2月至2015年2月行PTRAS治疗的172例ARAS患者的一般资料、围术期和随访情况,分析PTRAS治疗ARAS患者的安全性及临床疗效。结果本研究结果显示,与术前比较,术后72 h及远期随访,收缩压和舒张压均有明显下降,差异均有统计学意义(P<0.01)。在不同性别患者中,男性患者术后72 h血压、远期随访血压和女性患者术后72 h血压较术前均下降,差异均有统计学意义(P<0.05),但女性患者远期随访血压与术前比较无明显下降,差异无统计学意义(P>0.05)。PTRAS术后,对比剂诱导的急性肾损伤发生率为9.9%(17/172),多因素Logistic回归分析显示,急性心肌梗死和糖尿病是术后发生对比剂诱导急性肾损伤的独立危险因素。随访121例患者中,全因死亡11例(9.1%)。结论 PTRAS治疗的ARAS在术后72 h及远期随访期间,PTRAS可以有效改善ARAS引起的继发性高血压,且对比剂诱导的急性肾损伤发生率低。Objective To investigate the security and clinical efficacy of percutaneous transluminal renal artery stenting（ PTRAS） among patients with atherosclerotic renal artery stenosis（ ARAS）. Methods A retrospective study was performed on 172 patients with ARAS treated by PTRAS from February 1998 to February 2015,including baseline data,postoperative 72 hours and long term followup. Results Compared with preoperative,systolic blood pressure（ SBP） and diastolic blood pressure（ DBP） of postoperative 72 hours and long term follow-up was reduced significantly（ P 0. 01）. Patients in different genders compared with the preoperation,the blood pressure of postoperative 72 hours and long term follow-up in male patients,and the blood pressure of postoperative 72 hours in female were reduced significant（ P 0. 05）,while the blood pressure of long term follow-up in female were no reduced significantly（ P 0. 05）. The occurrence rate of contrast induced acute kidney injury after PTRAS was 9. 9 %（ 17 /172）,and multivariate analysis indicated that the diagnosis of acute myocardial infarction and diabetes mellitus were independent risk factors for postoperative contrast induced acute kidney injury during the follow-up period,there were 11 cases（ 9. 1 %） all-cause mortality. Conclusion PTRAS treatment of patients with ARAS,the renal function of postoperative 72 hours and long term follow-up is stable,and the incidence of contrast induced acute kidney injury is low.

关 键 词：动脉粥样硬化 肾动脉狭窄 经皮肾动脉支架术 血压 肾功能 

分 类 号：R543[医药卫生—心血管疾病]