经导管去肾交感神经治疗顽固性高血压——附两例报告Catheter based renal sympathetic denervation for resistant hypertension in 2 patients
李浪,黄江南,霍勇,葛均波,王伟民
摘要(Abstract)：
目的探讨经导管去肾交感神经治疗顽固性高血压的疗效。方法入选2例典型顽固性高血压患者,于全麻下使用Symplicity导管及射频仪对患者行经导管去肾交感神经术,螺旋式消融肾动脉内膜4～6个点,术中消融指标:每点消融时间2min,消融功率8W,消融阻抗250～350Ω,消融温度50～60℃。结果经过术后短期随访,两例患者血压控制良好。病例1患者血压由术后163/102mm Hg缓慢下降,术后第2天晨起血压125/90mm Hg,逐渐减少降压药,术后1个月行动态血压监测全天血压均值为129/82mm Hg。病例2患者血压由术后151/102mm Hg缓慢下降,术后第2天晨起血压120/78mm Hg,逐渐减少降压药,术后1个月行动态血压监测全天血压均值为130/81mm Hg。结论使用Symplicity导管及射频仪进行经导管去肾交感神经术,是治疗顽固性高血压有效的新方法。
关键词(KeyWords)： 肾动脉;交感神经切除术;高血压
基金项目(Foundation):
作者(Author): 李浪,黄江南,霍勇,葛均波,王伟民
参考文献(References)：
- [1]Mahfoud F,Himmel F,Ukena C,et al.Treatment strategies for resistant arterial hypertension.Dtsch Arztebl Int,2011,108:725-731.
- [2]Krum H,Schlaich M,Whitbourn R,et al.Catheter-based renal sympathetic denervation for resistant hypertension:a multicentre safety and proof-of-principle cohort study.Lancet,2009,373:1275-1281.
- [3]Martin EA,Victor RG.Premise,promise,and potential limitations of invasive devices to treat hypertension.Curr Cardiol Rep,2011,13:86-92.
- [4]Kaplan NM,Victor RG.Primary Hypertension:Pathogenesis//Clinical Hypertension10th ed.Philadelphia:Lippincott Williams&Wilkins,2009:42-107.
- [5]Thompson KA,Kar S,Makkar R,et al.Drug-resistant hypertension:is renal sympathetic denervation the answer?Curr Cardiol Rep,2011,13:93-95.
- [6]Gewirtz JR,Bisognano JD.Catheter-based renal sympathetic denervation:a targeted approach to resistant hypertension.Cardiol J,2011,18:97-102.
- [7]Tsioufis C,Kordalis A,Flessas D,et al.Pathophysiology of resistant hypertension:the role of sympathetic nervous system.Int J Hypertens,2011,10:1-7.
- [8]Lobodzinski SS.New developments in the treatment of severe drug resistant hypertension.Cardiol J,2011,18:707-711.
- [9]Symplicity HTN-2Investigators,Esler MD,Krum H,et al.Renal sympathetic denervation in patients with treatment-resistant hypertension(The Symplicity HTN-2Trial):a randomized controlled trial.Lancet,2010,376:1903-1909.
- [10]Schlaich MP,Sobotka PA,Krum H,et al.Renal sympathetic-nerve ablation for uncontrolled hypertension.N Engl J Med,2009,361:932-934.