肾动脉支架成形术对血压、肾功能影响及其临床应用价值

Renal artery stenting effect on blood pressure,renal function and clinical value

目的：探讨肾动脉支架成形术对患者血压、肾功能的影响及其应用价值。方法140例动脉硬化性肾动脉狭窄行肾动脉支架成形术患者，其中男85例（60．7％），女55例（39．3％）。年龄47～86岁，平均（67．4±9．82）岁。共施行了152条肾动脉支架置入，12例为双侧肾动脉分期介入治疗。分析手术并发症，随访患者的血压变化、服用降压药物种类及血肌酐、尿素氮变化，超声观察支架通畅情况。结果手术成功率100％。围术期并发症：肾周血肿5例（3．3％）；穿刺部位血肿5例（3．3％）；术后上消化道出血2例（1．3％）。围术期死亡1例（0．6％）。随访时间24个月，高血压患者服用降压药种类从术前平均（2．9±1．2）种下降至（1．9±1．3）种（P＜0．05）。总体上，高血压治愈0例，改善108例（77．1％），无效32例（22．9％）。介入手术后患者血压有所改善[术前收缩压（150．04±16．69） mmHg，术后（137．05±12．58） mmHg，P＜0．001；术前舒张压（81．69±12．02）mmHg，术后（79．29±8．71）mmHg，P＜0．05]；133例术前肾功能正常患者术后血清肌酐尿素氮检测低于术前水平[术前血肌酐（91．63±38．06）μmol/L，术后（87．69±40．31）μmol/L，P＜0．001；术前尿素氮（5．97±1．80） mmol/L，术后（5．63±1．83） mmol/L，P＜0．05]；7例术前肾功能不全患者介入治疗后肌酐尿素氮水平无明显改善。结论肾动脉支架成形术可以使肾动脉狭窄合并高血压患者的血压得以减轻或易于控制，同时有利于维持肾功能正常。

Objective 140 patients with atherosclerotic renal artery stenosis who underwent stenting angioplasty were analysed retrospectively to investigate the effects on hypertension control and renal function improvement after renal artery stenting .Methods One hundred and forty patients who underwent renal artery stenting between January 2007 and June 2011 were followed up .Among 140 patients[85 men, 55 women, age ranged from 47 to 86 years, mean age （67.4 ±9.82） years],a total of 152 renal artery stents were implanted and 12 patients underwent bilateral renal artery stent implantation .Post-operative complication , blood pressure variation and various kinds of hypotensors , serum creatinine , and urea nitrogen were recorded .Renal artery sonography was also performed to inves-tigate the patency after stenting .Results All operations were successful .There were 12 peri-operative complications , 5 perireal he-matomas, 5 hematomas at puncture site , 2 upper gastric hemorrhage .One patient died during peri-operative period.Follow-up for 24 months.Among patients with hypertension , kinds of antihypertensive drug decreased from 2.9 ±1.2 preoperatively to 1.9 ±1.3 post-operatively （P〈0.05）.After operation, patients’blood pressure also decreased [（systolic pressure （150.04 ±16.69）mmHg pre-op-eratively vs （137.05 ±12.58）mmHg post-operatively, P〈0.001; diastolic pressure （81.69 ±12.02）mmHg pre-operatively v.s. （79.29 ±8.71）mmHg post-operatively,P〈0.05）].No hypertensive patient was cured , but 108（77.1%） hypertensive patient were improved, while 32（22.9%） had no effect.In patients with normal renal function , serum creatinine and urea nitrogen decreased after stenting （pre-operative sCr （91.63 ±38.06） μmol/L, v.s.post-operative （87.69 ±40.31） μmol/L, P〈0.001;pre-operative BUN （5.97 ±1.800 mmol/L,vs post-operative （5.63 ±1.83） mmol/L,P〈0.05）.Patients complicated by pre-operative renal insufficien-cy did not get benefit on renal function after interventional procedure .Conclusions Renal artery stent implantation reduces high blood pressure in those who suffer from hypertension or be helpful for controlling blood pressure .In patients with normal renal function , glo-merular filtration rate also is improved after implantation .