彩色多普勒超声对肾动脉狭窄介入治疗中肾血流动力学的评价

Study on renal hemodynamics after interventional treatment of renal artery stenosis by color Doppler flow imaging

目的 以彩色多普勒超声评估肾动脉狭窄扩张成形术 (PTA)和支架植入术 (PTAS)后肾动脉血流动力学变化。方法 对比分析 19例肾动脉狭窄患者在PTA( 12例 )和PTAS( 7例 )介入治疗前后主肾动脉血流峰速度 (Vp)和肾内段动脉血流加速度 (Ac) ,并与健康人对照。 结果 PTA和PTAS介入治疗后狭窄肾动脉两端的压力梯度明显减小 ,Vp由 ( 2 6 9.5± 91.8)cm s和 ( 2 87.7± 10 1.6 )cm s分别降至 ( 137.3± 31.7)cm s和( 14 9.9± 40 .3)cm s ;Ac由 ( 10 9.2± 30 .1)cm s2 和 ( 10 8.6± 2 7.6 )cm s2 分别增至 ( 376 .3± 10 2 .7)cm s2 和 ( 35 0 .4± 16 6 .3)cm s2 ,治疗前、后差异有显著性意义 (P <0 .0 1) ;但介入治疗后肾动脉血流动力学仍不能恢复到正常 ,Vp和Ac值与正常对照组相比差异有显著性意义 (P <0 .0 1) ;PTA和PTAS治疗后肾动脉血流动力学改善情况两组比较差异无显著性意义 (P >0 .0 5 ) ;Ac依然是诊断再狭窄的重要参数。结论 彩色多普勒超声是评价肾动脉狭窄PTA和PTAS术疗效及识别再狭窄的一种无创、简便、可靠的检查方法。

Objective To evaluate the renal artery hemodynamic changes after renal artery stenosis percutaneous transluminal angioplasty (PTA) and percutaneous transluminal angioplasty stenting (PTAS) by color Doppler flow imaging (CDFI).Methods The information of 19 renal artery stenosis patients who had been treated by PTA (12 cases) and PTAS (7 cases) were analyzed. The peek velocity of the main renal artery (Vp) and acceleration of the intrarenal segmental artery (Ac) were compared with those before treatment and with healthy subjects′ data.Results The pressure gradient between two ends of renal artery stenosis decreased greatly after the treatment of PTA and PTAS. Vp declined respectively from ( 269.5 ± 91.8 )cm/s and ( 287.7 ± 101.6 )cm/s to ( 137.3 ± 31.7 )cm/s and ( 149.9 ± 40.3 )cm/s, while Ac increased from ( 109.2 ± 30.1 )cm/s 2 and ( 108.6 ± 27.6 )cm/s 2 to ( 376.3 ± 102.7 )cm/s 2 and ( 350.4 ± 166.3 )cm/s 2, the difference was significant (P< 0.01 ). Yet renal arteriel hemodynamics could not get recovery after interventional treatment, and the values of Vp and Ac differed considerably from those of healthy subjects (P< 0.01 ). The comparison of renal arterial hemodynamics improvement between PTA and PTAS treatment showed nothing notable (P> 0.05 ). Ac was still an important parameter for the diagnosis of re stenosis.Conclusions CDFI is an inspecting method to evaluate the curative effect of renal artery stenosis PTA & PTAS and to identify re stenosis, which is of no hurt, easy and reliable.