经皮经导管射频消融去肾交感神经术治疗难治性高血压

Renal denervation for the treatment of resistant hypertension

目的观察经皮经导管射频消融去肾交感神经术(RDN)对难治性高血压患者的降压效果,并分析其安全性和有效性。方法连续入选自2011-06-2012-03在天津市第一中心医院心内科住院治疗的难治性高血压患者20例,年龄25～75岁。使用Celsius标准电生理导管行RDN,观察术前及术后1周,1、3、6月的血压变化以及肌酐、估算的肾小球滤过率(eGFR)和心率等指标,评价手术的有效性与安全性并探讨其机制。结果 RDN后1周,1、3、6月患者的收缩压分别下降了23.5(95%CI15.9～31.2)、33.2(95%CI24.5～41.9)、37.9(95%CI28.8～47.1)、37.8(95%CI28.3～47.2)mmHg(均P<0.01)。术后1周,1、3、6月患者的舒张压分别下降了10.8(95%CI4.7～16.8)、15.5(95%CI8.3～22.7)、17.8(95%CI9.1～26.4)、18.1(95%CI9.4～26.8)mmHg(均P<0.01)。30.0%的患者术后减少了1种降压药,20.0%的患者术后减少了2种降压药。射频前后患者的血肌酐、eGFR差异无统计学意义,且无肾动脉狭窄、出血、血肿等不良事件发生。结论 RDN能够明显降低难治性高血压患者的血压,且术后患者的肾功能未有明显变化,无不良反应的发生。

Objective To observe the effects of renal denervation （RDN）on blood pressure reduction in resistant hy pertensive patients, and to assess the safety and effectiveness of the treatment. Methods Twenty resistant hypertensive inpatients from cardiovascular department of Tianjin First Center Hospital, aged from twenty-five to seventyfive, were consecutively selected between June 2011 and March 2012. All of these patients underwent RDN using the Celsius standard electrophysiological method. Before the operation, at 1 week, 1, 3 and 6 months after the operation, changes in blood pressure, serum creatinine, estimated glomerular filtration rate （eGFR）and heart rate were recorded, respectively. The effectiveness and safety of the operation were evaluated, and the mechanism of which was also investigated. Results At 1 week, 1, 3 and 6 months after the operation, the systolic blood pressure （SBP） of these patients decreased by 23.5 （95% CI 15.9-31.2）, 33.2 （95% CI 24.5-41.9）, 37.9 （95% CI 28.8 47.1）, and 37.8 （95 % CI 28.3-47.2）ram Hg,respectively（all P〈0.01）, and the diastolic blood pressure （DBP） was decreased by 10.8 （95% CI 4.7-16.8）, 15.5 （95%CI 8.3-22.7）, 17.8 （95% CI 9.1-26.4）, and 18.1（95% CI 9.4-26.8）mm Hg, respectively （all P〈0.01）. After the operation, the reduction of one antihy pertensive drug was seen in 30.0% of these patients, and the reduction of two antihypertensive drugs was observed in 20.0% of these patients. Before and after the operation, there was no statistically significant difference of the patient＇s serum creatinine and eGFR, respectively. And no renal artery stenosis, hemorrhage, hematoma and other adverse events occurred. Conclusions Renal denervation could significantly reduce blood pressure in patients with resistant hypertention. And no renal functional changes and adverse events were observed in these patients after the operation.