肾交感神经消融治疗顽固性高血压——基础研究与临床应用

The renal sympathetic denervation for resistant hypertension——the basic research and clinical application

顽固性高血压,往往合并心脑肾等靶器官的损害,是发生心血管事件的高危人群。研究已经证实交感神经的兴奋性程度与患者的血压水平呈正相关。20世纪50年代报道,外科去交感神经术用于高血压治疗,实施内脏神经、内脏交感神经切除术的效果和安全性未得到认可。20世纪70年代许多学者在不同实验高血压模型(遗传性、盐敏感性、肥胖型、肾动脉性高血压)上探索肾交感神经阻断方法,证实肾交感神经与高血压密切相关。2007年报道经皮导管肾脏交感神经消融术,选择性阻断肾脏交感神经,术后1、3、6、12个月血压分别下降14/10、22/11、22/10、26/11 mm Hg,治疗未发生消融相关严重并发症。随后的研究进一步证实其临床效果。经导管肾交感神经消融在顽固性高血压治疗的有效性和安全性得到初步确定。

The patients with resistant hypertension is the special population with high risk of cardiovascular events. It is confirmed that the excitability of the sympathetic was related to the blood pressure positive. In the 50 s of last century, the splanchnicectomy and sympathectomy were used in the treatment of the resistant hypertension but the effectiveness and safety were not approved. In the 70s of last century, many researchers had proved that the interruption of the renal sympathetic could lower the blood pressure in different hypertension models. In 2007 the minimally invasive method, catheter-renal sympathetic denervation （RSD） was reported in treatment of the resistant hyperten- sion. The blood pressure of the patients was reduced immediately after RSD and the results were maintained long term in most patients. The method was no severe complications related to the percu- taneous technique and radiofrequency ablation. The follow-up study had proved safety and efficacy with RSD.