经皮腔内治疗在高血压合并动脉粥样硬化性肾动脉狭窄老年患者中的应用效果及安全性

Safety and effectiveness of endovascular intervention therapy for atherosclerotic renal artery stenosis in old patients with hypertension

目的观察高血压合并动脉粥样硬化性肾动脉狭窄(ARAS)老年患者经皮腔内治疗的效果及安全性。方法45例老年高血压合并ARAS患者,采用经皮腔内治疗,术后随访12个月,观察治疗前后患者血压、降压药物种类、肾功能变化情况以及肾动脉支架通畅情况。结果 45例患者共51支肾动脉均成功完成经皮腔内治疗。术后5 d,患者收缩压为(157.78±12.36)mm Hg、舒张压为(94.87±6.12)mm Hg,血肌酐为(161.15±11.37)μmol/L,舒张压与术前比较,P<0.05;术后6个月时分别为(145.64±11.57)mm Hg、(77.42±7.63)mm Hg、(159.18±13.45)μmol/L,收缩压及舒张压与术前比较,P均<0.05;术后12个月时分别为(142.36±9.79)mm Hg、(74.97±8.82)mm Hg、(160.86±9.73)μmol/L,收缩压及舒张压与术前比较,P均<0.05。患者服用降压药物种类术前为(2.96±1.07)种,术后为(1.80±0.23)种,两者比较,P<0.05。所有患者均未出现严重并发症,4例患者因出现肾动脉支架再狭窄再次行经皮腔内肾动脉成形术。结论经皮腔内成形术治疗老年高血压合并ARAS效果好且安全。

Objective To observe the safety and effectiveness of endovascular interventional treatment for atherosclerot -ic renal artery stenosis （ ARAS） in old patients with hypertension .Methods Endovascular interventional treatments were performed in 45 old patients with hypertension combined with ARAS （ luminal narrowing≥70%） .The therapeutic effects were analyzed by means of blood pressure , types of hypotensors , renal function changes before and after therapy in average 12-month follow-up after operation .Results The percutaneous transluminal interventional treatment was successfully per -formed in 51 renal arteries of 45 patients.Five days after intervention , the systolic blood pressure decreased to （157.78 ± 12.36） mmHg, diastolic blood pressure decreased to （94.87 ±6.12） mmHg, and serum creatine （ Scr） was （161.15 ± 11.37）μmol/L.There was significant difference in the diastolic blood pressure as compared with that before treatment （P〈0.05）.Six months after intervention, the systolic blood pressure decreased to （145.64 ±11.57） mmHg, the diastolic blood pressure decreased to （77.42 ±7.63） mmHg, and Scr was （159.18 ±13.45）μmol/L.There were significant differences in the systolic and diastolic blood pressure as compared with that before treatment （all P〈0.05）.During the follow-up period for 12 months, the systolic blood pressure decreased to （142.36 ±9.79） mmHg, the diastolic blood pressure decreased to （74.97 ±8.82） mmHg, and Scr was （160.86 ±9.73） μmol/L.There were significant differences in the systolic and dias-tolic blood pressure as compared with that before treatment （all P〈0.05）.The number of hypotensors reduced from （2.96 ± 1.07） to （1.80 ±0.23） （P〈0.05）.All patients did not have serious complications , and 4 patients due to renal artery stent restenosis were performed with percutaneous transluminal renal angioplasty again .Conclusion The medium-term results of endovascular interventional treatment for ARAS in old patients with hypertension are safe and satisfactory .