腔内隔绝术治疗胸主动脉夹层动脉瘤对血压和肾功能的影响  

Influence of endovascular graft exclusion on renal function and blood pressure during treatment of thoracic aortic dissection

作　　者：陆清声[1] 景在平[1] 包俊敏[1] 赵志青[1] 冯翔[1] 赵珺[1] 冯睿[1] 黄晟[1] 熊江[1] 廖明芳[1] 赵新[1] 

机构地区：[1]第二军医大学长海医院血管外科,全军血管外科研究所上海200433

出　　处：《第二军医大学学报》2002年第8期846-847,共2页Academic Journal of Second Military Medical University

基　　金：军队杰出人才基金资助项目 (98J0 0 5 ) ;上海市卫生系统百名跨世纪优秀学科带头人培养计划基金(97BR0 4 7) ;上海市科技发展基金攻关计划项目(0 0 4 4 190 2 9) ;长海医院学科攀登计划基金资助课题

摘　　要：目的 :通过对 Stanford B型胸主动脉夹层动脉瘤腔内隔绝术前后患者血压和肾功能变化的观察 ,初步探讨此术式对患者血压和肾功能的影响及其可能机制。 方法 :共观察 111例。以平卧位右上肢肱动脉无创血压为标准 ,术前和术后 2周、3个月进行观察。术前、术后 1周内每日、术后 1个月检查患者血尿素氮和肌酐。测量患者术前、术后降主动脉真腔内径、肾动脉内径 ,了解肾脏真、假腔供血情况。结果 :术前并存高血压 82例 ,术后高血压改善 34例 (41.5 %)。术前肾功能正常者 94例 ,术后肾功能无明显变化 ;术前肾功能异常者 17例 ,术后出现肾功能异常一过性加重。术后肾动脉内径增大 2例 ,高血压均明显改善 ,肾功能无明显改善。术后肾动脉恢复真腔供血 9例中 ,6例高血压改善 ,肾功能均无明显改善。术后主动脉真腔明显增粗 11例 ,7例高血压改善。结论 :手术对患者血压的影响主要为在原有高血压基础上的改善。术后肾脏血供的改善、主动脉真腔增粗 ,血流阻力降低 ,可能是改善高血压的机制。手术对患者肾功能影响较小 。Objective:To study the change of blood pressure and renal function before and after endovascular graft exclusion (EVGE) for Stanford B thoracic aortic dissection(TAD). Methods:A total of 111 patients with Stanford B TAD were studied before and after EVGE. The non invasive blood pressure of right upper limb was measured before and 2 weeks, 3 months after the operation. The blood urea nitrogen and creatinine were detected before and per day in 1 week, 1 month after the operation. The diameter of aotic true lumen and renal artery were measured. Results:There were 82 hypertension patients in all Stanford B TAD patients before operation, and 34 of them were improved after operation. Ninty four patients whose preoperative renal function were normal had no change after operation. The 17 patients with preoperative renal function had transient renal function impairment. Blood pressures of 2 patients were improved after operation whose renal artery diameters were increased and renal function were not improved. Six patients hypertensions were improved after operation in the 9 patients whose renal arteries recovered true lumen origin and renal function were not improved after operation. Seven patients hypertensions were improved after operation in the 11 patients whose aortic true lumens became bigger. Conclusion:The influence of EVGE on blood pressure may be related to the improved renal artery supply, bigger aortic true lumen and decreased blood flow resistance. The effect of operation on renal function is slight and based on patient original renal function.

关 键 词：腔内隔绝术 治疗 胸主动脉夹层动脉瘤 血压 肾功能 

分 类 号：R543.16[医药卫生—心血管疾病]