CAJ | 학술논문

目的：对老年难治性高血压患者行经皮肾去交感神经术（RSD ），观察其有效性、安全性及可行性。方法选择连续难治性老年高血压患者20例，行经皮RSD ，观察术前和术后1、3、6个月随访时的诊室血压变化；术前和术后动态血压、血清肌酐、估算的肾小球滤过率、肾素活性、血管紧张素Ⅱ和醛固酮变化；手术并发症发生情况。结果与RSD前比较，患者RSD后1、3、6个月随访时诊室血压分别下降了16．9/11．9、24．8/17．1、29．1/20．5 mm Hg （1 mm Hg＝0．133 kPa ，P＜0．01），术后动态血压下降了24．2/17．2 mm Hg（P＜0．01），肌酐和估算的肾小球滤过率无显著变化（P＞0．05），肾素活性、血管紧张素Ⅱ和醛固酮显著下降（P＜0．05）；1例患者发生股动脉血肿。结论对老年高血压患者行经皮RSD可能安全、有效、可行。
목적：대노년난치성고혈압환자행경피신거교감신경술（RSD ），관찰기유효성、안전성급가행성。방법선택련속난치성노년고혈압환자20례，행경피RSD ，관찰술전화술후1、3、6개월수방시적진실혈압변화；술전화술후동태혈압、혈청기항、고산적신소구려과솔、신소활성、혈관긴장소Ⅱ화철고동변화；수술병발증발생정황。결과여RSD전비교，환자RSD후1、3、6개월수방시진실혈압분별하강료16．9/11．9、24．8/17．1、29．1/20．5 mm Hg （1 mm Hg＝0．133 kPa ，P＜0．01），술후동태혈압하강료24．2/17．2 mm Hg（P＜0．01），기항화고산적신소구려과솔무현저변화（P＞0．05），신소활성、혈관긴장소Ⅱ화철고동현저하강（P＜0．05）；1례환자발생고동맥혈종。결론대노년고혈압환자행경피RSD가능안전、유효、가행。
Objective To assess the efficiency ,safety and feasibility of percutaneous renal sympa-thetic denervation (RSD) for elderly refractory hypertension patients .Methods Office and ambu-latory blood pressures ,serum levels of creatinine ,angiotensin Ⅱ and aldosterone ,estimated glo-merular filtration rate (eGFR) and rennin activity were measured in 20 elderly refractory hyper-tension patients before and 1 ,3 ,6 months after percutaneous RSD .Complications of percutaneous RSD were observed .Results The office and ambulatory blood pressures were 16 .9/11 .9 mm Hg (1 mm Hg=0 .133 kPa) ,24 .8/17 .1 mm Hg ,29 .1/20 .5 mmHg and 24 .2/17 .2 mm Hg lower 1 , 3 ,6 months after percutaneous RSD than before percutaneous RSD ( P< 0 .01 ) .No significant difference was found in serum creatinine level and eGFR before and after percutaneous RSD (P>0 .05) .The creatinine ,angiotensin Ⅱand aldosterone levels were significantly lower after percuta-neous RSD than before percutaneous RSD (P<0 .05) .Femoral artery hematoma was detected in 1 patient .Conclusion Percutaneous RSD is a safe ,effective and feasible procedure for elderly re-fractory hypertension patients .