肾动脉主干加分支射频消融在难治性高血压治疗中的应用

Application of radiofrequency ablation of the main renal artery together with its branch in treating resistant hypertension

目的探讨肾动脉分支去神经化在经皮肾交感神经射频消融治疗难治性高血压中的应用。方法入选难治性高血压患者60例,完成肾动脉造影后随机分为单纯主支消融组、主支+分支消融组,各30例。观察分析患者基本资料,手术相关参数(消融点数、温度、平均能量),术前和术后2年诊室血压、动态血压等。结果两组患者年龄、伴发疾病、用药情况差异无统计学意义(P>0.05)。主支+分支消融组消融点数与单纯主支消融组相比呈显著增加趋势。两组患者术后诊室血压、动态血压均低于术前(P<0.05)。术后3~12个月期间主支+分支消融组诊室血压显著低于单纯主支消融组(P<0.001),但术后15~24个月期间两组差异无统计学意义(P>0.05)。结论肾动脉主支+分支消融术治疗难治性高血压安全有效,但远期随访中与单纯主支消融相比无明显优势。

Objective To study the application of denervation of renal artery branches through catheterbased renal sympathetic denervation(RND)therapy with radiofrequency ablation(RFA)of renal sympathetic nerves in the treatment of resistant hypertension.Methods A total of 60 patients with resistant hypertension were enrolled in this study.Renal angiography was performed in all patients.The patients were randomly divided into simple main renal artery RFA group(simple group,n=30)and main renal artery plus its branch RFA group(combination group,n=30).The patient’s basic data and operation-related parameters,including ablation points,temperature,average energy used,clinic blood pressure and dynamic blood pressure data before and 2 years after the treatment were analyzed.Results There were no statistically significant differences in age,associated diseases and use of drug between the two groups(P>0.05).The number of ablation points in the combination group was much more than that in the simple group.In both groups,the postoperative clinic blood pressure and dynamic blood pressure were lower than the preoperative ones(P<0.05).Within 3-12 months after RFA,the clinic blood pressure in the combination group was remarkably lower than that in the simple group(P<0.001),but in 15-24 months after RFA the difference in the clinic blood pressure between the two groups was not statistically significant(P>0.05).Conclusion For the treatment of resistant hypertension,RND with RFA of main renal artery plus its branch is safe and effective,although its long-term effect is not remarkably better than simple main renal artery RFA.