肾动脉消融治疗高血压--从生理解剖基础谈选择性消融

Renal denervation for hypertension:anatomical and physiologic basis for selective ablation

经皮去肾神经术(RDN)能够持久有效地降低血压。其临床证据充分,但尚存在降压效果不稳定等问题。近年来对肾脏神经支配和生理功能的认识逐渐加深,尤其是证实肾脏副交感神经的存在。肾脏副交感神经在功能上与交感神经相互拮抗,消融过程破坏了肾脏副交感神经可能是当前RDN效果不满意的一个重要原因。肾神经刺激引导的选择性消融可能是RDN技术未来的一个极具潜力的发展方向。

Percutaneous renal denervation(RDN)can effectively lower blood pressure in a sustainable manner.Its clinical evidence is solid,but there are still problems such unstable effect of blood pressure reduction.In recent years,our comprehension of the neural regulation and physiological functions of the kidney has been progressively deepening,particularly,the existence of the renal parasympathetic nerve has been confirmed.The renal parasympathetic nerve exerts opposing functions on the sympathetic nerve,and the ablation-induced impairment of the renal parasympathetic nerve may contribute significantly to the unsatisfactory efficacy observed in current RDN procedures.Selective ablation guided by renal nerve stimulation holds great promise as a future development direction for RDN technology.