肾血管性高血压的介入治疗

PTRAS for renovascular hypertension of renal artery stenosis

  • 摘要: 目的: 评估肾动脉狭窄所致高血压介入治疗的临床疗效。方法: 16例高血压患者(男10,女6),年龄36~65(51±9)岁,经肾动脉彩色多普勒超声和肾动脉造影检查证实,均患有严重的肾动脉狭窄,在球囊预扩张的基础上,置入球囊扩张支架,术后定期门诊随访血压和肾功。结果: 所有高血压患者术后血压均有明显下降,收缩压从(22.4±1.7)kPa降至(16.7±1.6)kPa;舒张压从(14.3±1.1)kPa降至(10.1±0.9)kPa。6例患者停用降压药物后血压仍维持在正常范围内,其余10名患者降压药从4~5种减至2种后血压仍能满意控制。随访8~12月,疗效能稳定维持。12例患者血肌酐水平稳定无明显变化,4例患者血肌酐水平降低,肾功能得到一定的改善。结论: 支架置入是治疗肾血管性高血压的安全有效方法,其初步疗效满意。

     

    Abstract: Objective: To evaluate the primary and clinical efficacy of percutaneous transluminal angioplasty and stenting in patients with renovascular hypertension of renal artery stenoses.Methods: 16 patients(10 males and 6 females),aged from 36 to 65(51±9) years,were diagnosed as renal artery stenoses by renal angiography.The lesions in 14 of them were considered to be atherosclerotic.Firstly,PTRA was performed,and then stents were successfully implanted into the renal arteries.All the balloon expandable stents were placed in 18 arteries(diameter reduction 70%-99%),and the clinical follow-up was done during 8-12 months(mean follow-up period of 8.3±3.2 months)at the outpatient department.The primary and midterm clinical efficacy of PTRAS(percutaneous transluminal renal angioplasty stenting) was evaluated based on the blood pressure response after PTRAS.Results: Procedure success rate was 100%.Early clinical improvement was seen in all patients.The mean systolic blood pressure was reduced from(22.4±1.7)kPa to(16.7±1.6)kPa,the diastolic blood pressure from(14.3±1.1)kPa to(10.1±0.9)kPa.6 of 16 patients no need to take any antihypertensive drugs maintained normal blood pressure,while another 10 patients reduced the antihypertensive drugs.Serum creatinine remained stable in 75% patients,and improved in 25% patients.Conclusion: Stent implantation appears to be a primary and effective treatment for renovascular hypertension control and less deleterious effect on renal function.

     

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