中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
4期
1586-1590
,共5页
邓锡伟%谭健锹%牛云茜%刘红%吴宝群%谭冠昶%段丽芳%吕敏莹
鄧錫偉%譚健鍬%牛雲茜%劉紅%吳寶群%譚冠昶%段麗芳%呂敏瑩
산석위%담건초%우운천%류홍%오보군%담관창%단려방%려민형
高血压%导管消融术%肾交感神经%肾动脉梗阻
高血壓%導管消融術%腎交感神經%腎動脈梗阻
고혈압%도관소융술%신교감신경%신동맥경조
Hypertension%Catheter ablation%Renal sympathetic nerve%Renat artery obstruction
目的探讨经导管肾交感神经射频消融术（ CRSD ）治疗老年顽固性高血压的有效性和安全性。方法对5例老年顽固性高血压患者实施CRSD，随访1～6个月。比较术前、术后的血压水平和用药情况及肌酐水平，术后行CT扫描检查肾动脉。结果在随访1个月时，收缩压和舒张压明显下降[（123.3±4.9）mm Hg/（73±6.2）mm Hg vs．（161.6±28.2）mm Hg/（85.8±5.6）mm Hg，P＜0.05]；在随访3个月时，收缩压和舒张压明显下降[（126.8±2.7）mmHg/（71.2±4.8）mm Hg vs．（161.6±28.2）mm Hg/（85.8±5.6） mm Hg，P＜0.05]；在随访6个月时，收缩压和舒张压明显下降[（118.7±3.9） mm Hg/（72.8±3.6） mm Hg vs．（161.6±28.2）mm Hg/（85.8±5.6）mm Hg，P＜0.05]，控制血压的疗效仍然存在，并未见严重低血压出现。在随访6个月时，患者的降压药种类，治疗后较治疗前明显减少[（2.5±0.4）种 vs．（4.3±0.8）种，P＜0.05]，其中硝苯地平剂量明显减少（30 mg vs．60 mg，P＜0.05）。术后随访未见肾动脉以及肾功能异常。结论 CRSD对治疗老年顽固性高血压有一定的有效性和安全性，且介入方法简单，在临床上值得谨慎地开展。
目的探討經導管腎交感神經射頻消融術（ CRSD ）治療老年頑固性高血壓的有效性和安全性。方法對5例老年頑固性高血壓患者實施CRSD，隨訪1～6箇月。比較術前、術後的血壓水平和用藥情況及肌酐水平，術後行CT掃描檢查腎動脈。結果在隨訪1箇月時，收縮壓和舒張壓明顯下降[（123.3±4.9）mm Hg/（73±6.2）mm Hg vs．（161.6±28.2）mm Hg/（85.8±5.6）mm Hg，P＜0.05]；在隨訪3箇月時，收縮壓和舒張壓明顯下降[（126.8±2.7）mmHg/（71.2±4.8）mm Hg vs．（161.6±28.2）mm Hg/（85.8±5.6） mm Hg，P＜0.05]；在隨訪6箇月時，收縮壓和舒張壓明顯下降[（118.7±3.9） mm Hg/（72.8±3.6） mm Hg vs．（161.6±28.2）mm Hg/（85.8±5.6）mm Hg，P＜0.05]，控製血壓的療效仍然存在，併未見嚴重低血壓齣現。在隨訪6箇月時，患者的降壓藥種類，治療後較治療前明顯減少[（2.5±0.4）種 vs．（4.3±0.8）種，P＜0.05]，其中硝苯地平劑量明顯減少（30 mg vs．60 mg，P＜0.05）。術後隨訪未見腎動脈以及腎功能異常。結論 CRSD對治療老年頑固性高血壓有一定的有效性和安全性，且介入方法簡單，在臨床上值得謹慎地開展。
목적탐토경도관신교감신경사빈소융술（ CRSD ）치료노년완고성고혈압적유효성화안전성。방법대5례노년완고성고혈압환자실시CRSD，수방1～6개월。비교술전、술후적혈압수평화용약정황급기항수평，술후행CT소묘검사신동맥。결과재수방1개월시，수축압화서장압명현하강[（123.3±4.9）mm Hg/（73±6.2）mm Hg vs．（161.6±28.2）mm Hg/（85.8±5.6）mm Hg，P＜0.05]；재수방3개월시，수축압화서장압명현하강[（126.8±2.7）mmHg/（71.2±4.8）mm Hg vs．（161.6±28.2）mm Hg/（85.8±5.6） mm Hg，P＜0.05]；재수방6개월시，수축압화서장압명현하강[（118.7±3.9） mm Hg/（72.8±3.6） mm Hg vs．（161.6±28.2）mm Hg/（85.8±5.6）mm Hg，P＜0.05]，공제혈압적료효잉연존재，병미견엄중저혈압출현。재수방6개월시，환자적강압약충류，치료후교치료전명현감소[（2.5±0.4）충 vs．（4.3±0.8）충，P＜0.05]，기중초분지평제량명현감소（30 mg vs．60 mg，P＜0.05）。술후수방미견신동맥이급신공능이상。결론 CRSD대치료노년완고성고혈압유일정적유효성화안전성，차개입방법간단，재림상상치득근신지개전。
Objective To investigate the safety and efficacy of catheter-based renal sympathetic denervation ( CRSD) in the treatment of resistant hypertension in old patients .Methods 5 patients with resistant hypertension were treated with CRSD and followed-up from 1 to 3 months.Their blood pressure,creatinine level and medication were recorded and compared before and after the procedure .CT scan was scheduled to observe renal artery in follow-up.Results In the follow-up of 1 month,the systolic and diastolic blood pressure were significantly lowered than that of the procedure before[(123.3 ±4.9)mm Hg/(73 ±6.2)mm Hg vs.(161.6 ±28.2)mm Hg/(85.8 ±5.6)mm Hg,P<0.05].In the follow-up of 3 months,the systolic and diastolic blood pressure were significantly lowered than that of the procedure before[(126.8 ±2.7)mmHg/(71.2 ±4.8)mm Hg vs.(161.6 ±28.2)mm Hg/(85.8 ±5.6) mm Hg,P<0.05].In the follow-up of 6 months,the systolic and diastolic blood pressure were significantly lowered than that of the procedure before [(118.7 ±3.9)mm Hg/(72.8 ±3.6)mm Hg vs.(161.6 ±28.2)mm Hg/(85.8 ± 5.6 ) mm Hg,P<0.05 ] .The anti-hypertensive effect still existed and no severe hypotension was observed .In the follow-up of 6 months,the kinds of hypertensive medication were significantly reduced (2.5 ±0.4 vs.4.3 ±0.8,P<0.05).The dose of Nifedipine was also reduced significantly (30 mg vs.60 mg,P<0.05).No abnormality of renal artery and renal function was observed after the procedure .Conclusions CRSD is a relatively simple ,safe and effect interventional therapy to treat resistant hypertension in old patients .It deserves promotion in clinical practice with caution .
