摘要
目的探索去肾神经术(RDN)不同消融点数对难治性高血压降压疗效的影响。方法入选2013-2015年上海市普陀区中心医院心内科诊断为难治性高血压的患者48例,行RDN,按术中消融点数不同将其分为传统手术组(不超过8个点,23例)和加强手术组(最少8个点,25例)。术中记录消融参数(消融点数、消融阻抗、消融实际功率、消融实际温度),术后即刻复查肾动脉造影。所有患者术后继续监测血压,随访至术后6个月。结果术后即刻造影患者均未出现动脉夹层、肾脏灌注不足、血流动力学紊乱等不良事件。术后随访6个月,除6例患者因不良事件被剔除,余患者均未出现肝肾功能损伤现象,动脉夹层、血流动力学紊乱等不良事件的发生率差异无统计学意义。术后随访中,传统手术组(n=21)24 h平均收缩压/舒张期降低,加强手术组(n=21)降低幅度更明显[(25.1±11.4)/(10.1±9.6)比(8.0±10.6)/(3.1±6.1)mm Hg,P<0.01],收缩压及舒张压下降量与消融点数呈正相关。结论RDN能够显著降低难治性高血压患者的血压,手术安全有效,同时术中消融点数越多降压效果越明显,应进一步研究。
Objective To compare the efficacy of different numbers of ablation points used in the renal sympathetic denervation(RDN)on resistant hypertension patients.Methods A total of 48 patients with resistant hypertension were recruited from cardiology department of Central Hospital of Shanghai Putuo District from 2013 to 2015.According to different numbers of ablation points used in RDN,these patients were divided into traditional(<8 points,n=23)and strengthening ablation(≥8 points,n=25)group.The ablation parameters,including numbers of points,impedance,actual wattage,and the actual temperature were recorded during the operation.Renal angiography was done again after RDN.Standardized blood pressure images were available for all patients 6 months after the operation.Results There were no adverse events such as arterial dissection,insufficient renal perfusion and hemodynamic disorder in the immediate angiography of the these patients after RDN.After 6 months of the operation,six patients withdrew from the study due to adverse events;there was no damage of liver and kidney function,and no statistical significance in the incidence of adverse events such as arterial dissection and hemodynamic disorder in the rest.During the follow-up,the decreases of 24-hour systolic/diastolic blood presssure in the strengthening ablation group were greater than traditional ablation group[(25.1±11.4)/(10.1±9.6)vs(8.0±10.6)/(3.1±6.1)mm Hg,P<0.01].There was a positive correlation between ablation points and the decrease of 24-hour systolic/diastolic.Conclusion RDN can significantly reduce the blood pressure in patients with resistant hypertension safely and effectively.The more ablation points used in the operation,the more obvious blood pressure reduction is,which should be further studied.
作者
张华
李凌燕
张弘
吕天娇
李清丽
邓伟明
段秋霞
郜俊清
刘宗军
ZHANG Hua;LI Ling-yan;ZHANG Hong;LüTian-jiao;LI Qing-li;DENG Wei-ming;DUAN Qiu-xia;GAO Jun-qing;LIU Zong-jun(Department of Putuo District Central Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200062)
出处
《中华高血压杂志》
CAS
CSCD
北大核心
2020年第1期37-42,共6页
Chinese Journal of Hypertension
基金
上海市医学重点专科建设计划项目-心血管内科(ZK2015A17)
上海市卫计委卫生行业临床研究专项项目(201840247).
