CAJ | 학술논문

目的：观察高血压合并动脉粥样硬化性肾动脉狭窄（ ARAS）老年患者经皮腔内治疗的效果及安全性。方法45例老年高血压合并ARAS患者，采用经皮腔内治疗，术后随访12个月，观察治疗前后患者血压、降压药物种类、肾功能变化情况以及肾动脉支架通畅情况。结果45例患者共51支肾动脉均成功完成经皮腔内治疗。术后5 d，患者收缩压为（157．78±12．36）mmHg、舒张压为（94．87±6．12）mmHg，血肌酐为（161．15±11．37）μmol／L，舒张压与术前比较，P＜0．05；术后6个月时分别为（145．64±11．57） mmHg、（77．42±7．63） mmHg、（159．18±13．45）μmol／L，收缩压及舒张压与术前比较，P均＜0．05；术后12个月时分别为（142．36±9．79） mmHg、（74．97±8．82） mmHg、（160．86±9．73）μmol／L，收缩压及舒张压与术前比较，P均＜0．05。患者服用降压药物种类术前为（2．96±1．07）种，术后为（1．80±0．23）种，两者比较，P＜0．05。所有患者均未出现严重并发症，4例患者因出现肾动脉支架再狭窄再次行经皮腔内肾动脉成形术。结论经皮腔内成形术治疗老年高血压合并 ARAS效果好且安全。
목적：관찰고혈압합병동맥죽양경화성신동맥협착（ ARAS）노년환자경피강내치료적효과급안전성。방법45례노년고혈압합병ARAS환자，채용경피강내치료，술후수방12개월，관찰치료전후환자혈압、강압약물충류、신공능변화정황이급신동맥지가통창정황。결과45례환자공51지신동맥균성공완성경피강내치료。술후5 d，환자수축압위（157．78±12．36）mmHg、서장압위（94．87±6．12）mmHg，혈기항위（161．15±11．37）μmol／L，서장압여술전비교，P＜0．05；술후6개월시분별위（145．64±11．57） mmHg、（77．42±7．63） mmHg、（159．18±13．45）μmol／L，수축압급서장압여술전비교，P균＜0．05；술후12개월시분별위（142．36±9．79） mmHg、（74．97±8．82） mmHg、（160．86±9．73）μmol／L，수축압급서장압여술전비교，P균＜0．05。환자복용강압약물충류술전위（2．96±1．07）충，술후위（1．80±0．23）충，량자비교，P＜0．05。소유환자균미출현엄중병발증，4례환자인출현신동맥지가재협착재차행경피강내신동맥성형술。결론경피강내성형술치료노년고혈압합병 ARAS효과호차안전。
Objective To observe the safety and effectiveness of endovascular interventional treatment for atherosclerot -ic renal artery stenosis ( ARAS) in old patients with hypertension .Methods Endovascular interventional treatments were performed in 45 old patients with hypertension combined with ARAS ( luminal narrowing≥70%) .The therapeutic effects were analyzed by means of blood pressure , types of hypotensors , renal function changes before and after therapy in average 12-month follow-up after operation .Results The percutaneous transluminal interventional treatment was successfully per -formed in 51 renal arteries of 45 patients.Five days after intervention , the systolic blood pressure decreased to (157.78 ± 12.36) mmHg, diastolic blood pressure decreased to (94.87 ±6.12) mmHg, and serum creatine ( Scr) was (161.15 ± 11.37)μmol/L.There was significant difference in the diastolic blood pressure as compared with that before treatment (P<0.05).Six months after intervention, the systolic blood pressure decreased to (145.64 ±11.57) mmHg, the diastolic blood pressure decreased to (77.42 ±7.63) mmHg, and Scr was (159.18 ±13.45)μmol/L.There were significant differences in the systolic and diastolic blood pressure as compared with that before treatment (all P<0.05).During the follow-up period for 12 months, the systolic blood pressure decreased to (142.36 ±9.79) mmHg, the diastolic blood pressure decreased to (74.97 ±8.82) mmHg, and Scr was (160.86 ±9.73) μmol/L.There were significant differences in the systolic and dias-tolic blood pressure as compared with that before treatment (all P<0.05).The number of hypotensors reduced from (2.96 ± 1.07) to (1.80 ±0.23) (P<0.05).All patients did not have serious complications , and 4 patients due to renal artery stent restenosis were performed with percutaneous transluminal renal angioplasty again .Conclusion The medium-term results of endovascular interventional treatment for ARAS in old patients with hypertension are safe and satisfactory .