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
24期
11739-11741
,共3页
心力衰竭,收缩性%临床试验%交感神经%去肾脏交感神经%血管紧张素
心力衰竭,收縮性%臨床試驗%交感神經%去腎髒交感神經%血管緊張素
심력쇠갈,수축성%림상시험%교감신경%거신장교감신경%혈관긴장소
Heart failure,systolic%Clinical trial%Sympathetic nerves%Renal sympathetic denervation%Angiotensin
交感神经是心脏和肾脏通过血流动力学和神经体液机制相互影响，从而维持血液循环的稳定过程中非常重要的环节。但是在充血性心力衰竭时，这种正常的调节机制就变得不恰当。交感神经在充血性心力衰竭中被激活，肾脏交感传入神经的激活，反馈性的增加中枢交感神经系统张力，从而升高外周血管阻力、促进血管及左心室重构；肾脏交感传出神经激活，不仅降低肾血流、减少水钠排泄，激活了肾素-血管紧张素系统，从而促进心肌及心脏神经系统重构，加重心肾功能不全。因此，交感神经的活性增加预示着充血性心力衰竭患者生存率降低。胸部高位交感神经阻滞术、颈部迷走神经刺激术以及去肾脏神经（RD）术都已经显示了一定改善慢性心力衰竭的作用。随着导管技术的不断发展，经肾动脉射频消融RD技术已经有望临床应用于治疗充血性心力衰竭。本文将综述干预交感神经治疗充血性心力衰竭相关的基础及临床研究进展，并对国内外正在进行的临床试验加以介绍。
交感神經是心髒和腎髒通過血流動力學和神經體液機製相互影響，從而維持血液循環的穩定過程中非常重要的環節。但是在充血性心力衰竭時，這種正常的調節機製就變得不恰噹。交感神經在充血性心力衰竭中被激活，腎髒交感傳入神經的激活，反饋性的增加中樞交感神經繫統張力，從而升高外週血管阻力、促進血管及左心室重構；腎髒交感傳齣神經激活，不僅降低腎血流、減少水鈉排洩，激活瞭腎素-血管緊張素繫統，從而促進心肌及心髒神經繫統重構，加重心腎功能不全。因此，交感神經的活性增加預示著充血性心力衰竭患者生存率降低。胸部高位交感神經阻滯術、頸部迷走神經刺激術以及去腎髒神經（RD）術都已經顯示瞭一定改善慢性心力衰竭的作用。隨著導管技術的不斷髮展，經腎動脈射頻消融RD技術已經有望臨床應用于治療充血性心力衰竭。本文將綜述榦預交感神經治療充血性心力衰竭相關的基礎及臨床研究進展，併對國內外正在進行的臨床試驗加以介紹。
교감신경시심장화신장통과혈류동역학화신경체액궤제상호영향，종이유지혈액순배적은정과정중비상중요적배절。단시재충혈성심력쇠갈시，저충정상적조절궤제취변득불흡당。교감신경재충혈성심력쇠갈중피격활，신장교감전입신경적격활，반궤성적증가중추교감신경계통장력，종이승고외주혈관조력、촉진혈관급좌심실중구；신장교감전출신경격활，불부강저신혈류、감소수납배설，격활료신소-혈관긴장소계통，종이촉진심기급심장신경계통중구，가중심신공능불전。인차，교감신경적활성증가예시착충혈성심력쇠갈환자생존솔강저。흉부고위교감신경조체술、경부미주신경자격술이급거신장신경（RD）술도이경현시료일정개선만성심력쇠갈적작용。수착도관기술적불단발전，경신동맥사빈소융RD기술이경유망림상응용우치료충혈성심력쇠갈。본문장종술간예교감신경치료충혈성심력쇠갈상관적기출급림상연구진전，병대국내외정재진행적림상시험가이개소。
The heart and kidney interact through hemodynamic and neurohumoral regulatory mechanisms, which help maintain circulatory homeostasis under normal conditions, and the renal sympathetic nerves plays an important role in this process. However, these normal regulatory mechanisms become inappropriate in congestive heart failure (CHF). The renal sympathetic nerves were activated in CHF. The activation of the afferent sympathetic nerve increases the central sympathetic tone, thereby increasing peripheral vascular resistance and promoting vascular and left ventricular remodeling while activation of the efferent sympathetic nerve not only decreases renal blood flow and reduces water and sodium excretion, but also activates the renin-angiotensin system, which finally promotes remodeling of the myocardium and cardiac autonomic nervous system, and increases cardio-renal dysfunction. Thus, the increased activity of the renal sympathetic nerves indicating decreased survival in CHF. In animal models of CHF, surgical renal denervation (RD) has been shown to improve both ventricular function and renal water and sodium retention. As catheter-based techniques evolve, RD through percutaneous catheter ablation of the renal artery has become a possible clinical treatment for CHF. This paper reviews the basic and clinical research developments of RD in the treatment of CHF along with an introduction to ongoing clinical trials which investigating the safety and efficacy of RD in patients with CHF.
