三维标测指导下肾动脉去交感神经术在中青年高血压患者中的疗效和安全性  

The efficacy and safety of renal denervation guided by three-dimensional mapping system in young and middle-aged patients with hypertension

作　　者：何德化[1] 张紫冠[1] 邓琴升 刘祖恒 张思婷 林惠燕 郑武扬[1] 谢强[1] 李卫华[1] 黄峥嵘[1] HE Dehua;ZHANG Ziguan;DENG Qinsheng;LIU Zuheng;ZHANG Siting;LIN Huiyan;ZHENG Wuyang;XIE Qiang;LI Weihua;HUANG Zhengrong(Department of Cardiology,the First Affiliated Hospital of Xiamen University,Xiamen Institute of Cardiovascular Disease,Xiamen Hypertension Prevention and Control Center,Xiamen Hypertension Quality Control Center Xiamen,Xiamen,Fujian 361003,China;Siming District Zhonghua Street Community Health Service Center)

机构地区：[1]厦门大学附属第一医院心内科,厦门市心血管病研究所,厦门市高血压防治中心,厦门市高血压质控中心,福建厦门361003 [2]厦门市思明区中华街道社区卫生服务中心

出　　处：《中华高血压杂志（中英文）》2024年第9期852-858,共7页Chinese Journal of Hypertension

基　　金：厦门市科技计划项目(3502Z20209020)。

摘　　要：目的 探讨三维标测指导下肾动脉去交感神经术(RDN)在中青年高血压中的疗效和安全性。方法 纳入2022年3月至2023年3月在厦门大学附属第一医院心血管内科行CARTO三维标测指导下应用压力监测冷盐水灌注导管行RDN的中青年原发性高血压患者24例,所有患者在接受RDN前均严格生活方式干预半年。采用自身对照,观察RDN的手术相关并发症以及基线、术后1周、术后1月和术后6月患者的诊室血压和心率、24 h动态血压、24 h平均心率、家庭自测血压和心率,以及降压药强度积分;同时评估肌酐、尿素、微量白蛋白、尿微量白蛋白/尿肌酐比值、肾小球滤过率和肾动脉形态。结果 24例患者均成功完成RDN手术操作,左右侧肾动脉平均消融位点分别为(12.1±3.4)个和(12.8±2.6)个。24例患者中出现肾动脉分支壁间血肿和夹层各1例(共占8.3%),无肾动脉主支夹层、破裂和狭窄等严重并发症;股动脉穿刺部位出现局部瘀斑16例(66.7%),无动静脉瘘、血肿等。所有患者在RDN治疗后均延续严格的生活方式管理。与RDN术前比较,随访至6月,患者的诊室血压、诊室心率、24h平均血压、24h平均心率、家庭自测血压及心率明显下降(均P<0.05);降压药强度积分下降(基线,术后1周、1月和6月的降压药强度积分分别为0.96±0.06、0.89±0.04、0.73±0.04和0.48±0.09,F=17.851,P<0.001);肾功能相关指标差异无统计学意义(均P>0.05),且肾动脉形态无异常。结论 中青年高血压患者CARTO三维标测指导下应用压力监测冷盐水灌注导管行RDN有助于进一步降低血压,且安全性良好。Objective To explore the efficacy and safety of renal denervation(RDN) guided by three-dimensional mapping system in young and middle-aged patients with hypertension.Methods A total of 24 young and middle-aged patients with primary hypertension were included,who underwent RDN using pressure sensing cold saline infusion catheter guided by CARTO three-dimensional mapping system at the Department of Cardiology of the First Affiliated Hospital of Xiamen University,from March 2022 to March 2023.All patients underwent strict lifestyle management for six months before receiving RDN.Using a self-controlled design to observe the surgical-related complications of RDN and assess the effects on patients' office blood pressure,office heart rate,24-hour ambulatory blood pressure,24-hour average heart rate,home blood pressure,home heart rate and the anti-hypertensive therapeutic intensity score at baseline,1 week,1 month,and 6 months after surgery.Additionally,evaluations were performed on serum creatinine,serum urea,urinary microalbumin,urinary microalbumin-to-creatinine ratio,glomerular filtration rate,and renal artery morphology.Results All 24 patients successfully completed RDN,with an average of(12.1±3.4) and(12.8±2.6) ablation points on the left and right renal arteries,respectively.Among the 24 patients,there was 1 case of renal artery branch intramural hematoma and 1 case of dissection(a total of 8.3%),and no severe complications such as renal artery main branch dissection,rupture,or stenosis were observed.16 cases(66.7%) showed local ecchymosis at the puncture site of the femoral artery,without arteriovenous fistula or hematoma.All patients continued strict lifestyle management after RDN.Comparison with pre-RDN,patients exhibited a significant decrease in office blood pressure,office heart rate,24-hour average blood pressure,24-hour average heart rate,and home blood pressure and home heart rate(all P<0.05),and the anti-hypertensive therapeutic intensity score decreased(the scores were 0.96±0.06,0.89±0.04,0.73±0.04

关 键 词：肾动脉去交感神经术 高血压 交感神经系统 心血管疾病 

分 类 号：R544.1[医药卫生—心血管疾病]