应用单圈消融法行经皮肾去交感神经治疗难治性高血压的临床研究

Clinical study on application of single circle percutaneous renal sympathetic denervationin for the treatment of refractory hypertension

目的对比单圈消融法与螺旋消融法行经皮肾去交感神经(RSD)治疗难治性高血压的有效性和安全性。方法选择40例难治性高血压患者行RSD,随机分为单圈消融组(简称单圈组)和螺旋消融组(简称螺旋组),观察术前和术后6个月时的动态血压(ABPM)和心率变化,以及术后不良反应发生情况。结果与术前比较,两组患者术后6个月ABPM均显著下降,单圈组[(138.4±9.2/86.1±7.4)mm Hg vs(158.3±18.6/98.6±9.5)mm Hg,P<0.001],螺旋组[(145.5±12.0/91.3±8.2)mm Hg vs(156.4±19.8/96.8±8.4)mm Hg,P<0.05],二组心率均较术前显著下降,单圈组[(72.3±8.2)次/分vs(89.7±16.4)次/分,P<0.001],螺旋组[(78.3±10.3)次/分vs(86.5±14.8)次/分,P<0.05]。与螺旋组相比,单圈组ABPM和心率明显下降(P<0.05)。两组术后均无不良反应发生。结论应用单圈消融法行RSD治疗难治性高血压是有效和安全的,优于螺旋式消融法。

Objective To compare the effectiveness and safety of single circle and spiral percutaneous renal sympathetic denervation （RSD） in the treatment of refractory hypertension. Methods Forty patients with refractory hypertension treated with percutaneous renal sympathetic nerve ablation were randomly divided into single circle ablation group （ single circle group） and spiral ablation group（ spiral group）. The ambulatory blood pressure（ABPM） and the average heart rate were assessed before and 6 months after operation. The postoperative adverse reactions were also observed. Results The ABPM of two groups was decreased significantly at sixth month after operation compared with that before operation, [ single circle group （ 138.4±9.2/86.1 ±7.4 ） mmHg vs （ 158.3±18.6/98.6 ±9.5 ） mmHg, spiral group （ 145.5 ± 12.0/91.3 ±8.2 ） mmHg vs （156.4±19.8/96.8±8.4）mmHg, P〈0. 001 and 0.05 respectively]. At the same time the average heart rate was significantly lower than that before surgery [ single circle group （72.3 ±8.2）bpm vs （89.7 ±16.4 ）bpm, spiral group （ 78.3 ± 10.3 ） bpm vs （86.5 ±14.8 ） bpm, P〈0.05 respectively ]. The ABPM and the heart rate of 6 months after operation were observed lower in single circle group than those in spiral grouP（ P〈0.05, respectively）. No adverse reactions were observed after operation in two groups. Conclusion The RSD treatment with single circle RSD in refractory hypertension is effective and safe, which maybe superior to that with spiral RSD. [ Chinese Journal of Cardiac Pacing and Electrophysiology,2015,29（6） ：554-557]