经皮肾动脉成形术对肾动脉狭窄患者血压和肾功能的影响

Effects of Percutaneous Transluminal Renal Arterioplasty on Blood Pressure and Renal Function in Patients with Renal Artery Stenosis

目的探讨经皮肾动脉成形术对肾动脉狭窄患者血压和肾功能的影响。方法选择经皮肾动脉成形术治疗的23例肾动脉狭窄患者作为研究对象,对其临床资料进行回顾性分析,观察术后血压和肾功能的变化并分析疗效。结果 23例患者均成功植入肾动脉支架,术后残留狭窄均小于30%,手术成功率为100%,术中术后均未发生严重并发症。术后均随访12个月,高血压治愈3例,改善17例,总改善率为86.9%;肾功能改善6例,稳定13例,总获益率为82.6%。收缩压由180.3±35.6 mmHg降为131.2±25.4 mmHg,舒张压由106.2±21.5 mmHg降为80.6±14.2 mmHg,血肌酐由286.4±113.7μmol/L降为166.5±84.8μmol/L,手术前后比较差异有统计学意义(P<0.05)。结论经皮肾动脉成形术和肾动脉支架植入治疗肾动脉狭窄的手术成功率高,有助于控制血压和稳定肾功能,远期疗效需进一步随访观察。

Aim To investigate the effect of percutaneous transluminal renal arterioplasty（PTRA） on blood pressure and renal function in patients with renal artery stenosis（RAS）. Methods 23 patients with renal artery stenosis treated by PTRA were selected as the study subjects and their clinical data were retrospectively analyzed to observe the changes in blood pressure and renal function and to analyze the efficacy. Results 23 patients were successfully implanted the renal artery stent with no serious intraoperative and postoperative complications,the residual stenosis were less than 30%and the surgical successful rate was 100%. Patients were followed up for 12 months,3 cases were cured of hypertension,17 cases improved,the total improvement rate was 86.9%;6 cases were improved of renal function,13 cases of stability,the total benefit rate was 82.6%. Systolic blood pressure（SBP） reduced from 180.3±35.6 mmHg to 131.2±25.4 mmHg,diastolic blood pressure（DBP） reduced from 106.2±21.5 mmHg to 80.6±14.2 mmHg,serum creatinine reduced from 286.4±113.7 μmol/L to 166.5±84.8 μmol/L,the difference between before and after surgery was significant（P0.05）. Conclusions PTRA and renal artery stenting for the treatment of RAS has high success rate. It can control the blood pressure and stabilize the renal function,while its long-term efficacy needs further investigation.