经导管射频消融去肾交感神经术对顽固性高血压患者的治疗效果

Therapeutic effect of renal sympathetic denervation by transcatheter radiofrequency ablation for treating resistant hypertension

目的探讨经导管射频消融去肾交感神经术对顽固性高血压患者的治疗效果。方法选择2014年1月至2014年9月收治的顽固性高血压病患者73例作为研究对象,所有患者均实施经导管射频消融去肾交感神经术:双肾动脉造影后,经股动脉送入36C17R消融导管至肾动脉主干远端,由导管头端分段释放5 W×120 s电能。应用24 h动态血压观察手术前、手术后1、3、6个月血压,比较手术前后服用降压药的种类。结果手术后1个月、3个月和6个月患者血压(收缩压/舒张压)水平[(128.53±12.46/83.68±9.43)mm Hg、(125.39±9.58/74.52±7.09)mm Hg、(124.06±9.25/73.80±7.04)mm Hg]均明显少于手术前血压(收缩压/舒张压)水平[(164.42±23.79/95.79±16.42)mm Hg],差异有统计学意义(P均<0.05)。手术后服用降压药物种类也明显低于手术前[(2.26±0.71)种vs(5.34±1.64)种,P<0.05]。结论经导管射频消融去肾交感神经术可有效控制顽固性高血压患者的血压,并减少使用降压药物的种类。

Objective To explore the therapeutic effect of renal sympathetic denervation by radiofrequency catheter ablation for the treatment of resistant hypertension. Methods Seventy-three patients with resistant hypertension admitted from January 2014 to September 2014 were selected as research objects. Renal sympathetic denervation by transcatheter radiofrequency ablation was performed in all patients. The procedure was as follows: after bilateral renoarteriography,the 36C17 R ablation catheter was sent to the far-end of main renal artery via femoral artery,and the electric energy of 5 W × 120 s was segmented released from catheter tip. The blood pressures before procedure and 1-,3-and 6-month after procedure were observed by 24-hour ambulatory blood pressure,and the kinds of antihypertensive drugs in pre-and post-procedure were compared. Results The levels of blood pressure( systolic pressure / diastolic pressure) 1-,3-and 6-month after procedure[( 128. 53 ± 12. 46 /83. 68 ± 9. 43) mm Hg,( 125. 39 ± 9. 58 /74. 52 ± 7. 09) mm Hg,( 124. 06 ± 9. 25 /73. 80 ± 7. 04) mm Hg] were all significant lower than that before procedure[( 164. 42 ± 23. 79 /95. 79 ± 16. 42) mm Hg]( all P < 0. 05). The kinds of antihypertensive drugs taken by patients after procedure decreased significantly compared with pre-procedure[( 5. 34 ± 1. 64) kinds of drugs vs( 2. 26 ± 0. 71) kinds of drugs,P < 0. 05]. Conclusions The renal sympathetic denervation by radiofrequency catheter ablation can effectively control blood pressure level of resistant hypertension patients and reduce the kinds of antihypertensive drugs taken by patients.