| 摘要: |
| 目的 探讨血流储备分数(FFR)压力导丝监测对指导经皮肾动脉交感神经消融术(RDN)的可行性。方法 将11头实验用小型猪分为2组,8头为RDN组,3头为假手术组。消融前先进行左、右肾动脉造影,然后以7F导引导管作为指引,于肾动脉内分别置入射频消融导管和FFR压力导丝,在X线透视下观察导管贴靠肾动脉情况,在肾动脉内不同位置进行电刺激(20 Hz),监测FFR数值(肾动脉压力/主动脉压力)。当FFR数值出现显著改变时,即在该靶点处进行消融(50℃,10 W,60 s)。消融后即刻重复刺激,如果未观察到以上指标的改变,即认为消融有效。结果 RDN组8头实验用小型猪均成功完成肾动脉靶点消融术。消融术前,在靶点处进行电刺激,FFR数值下降,差异有统计学意义(0.98±0.02 vs 0.73±0.07,P<0.01);消融术后即刻,在同样的点位进行电刺激,FFR数值几乎没有变化(0.97±0.03 vs 0.95±0.02,P=0.25)。在假手术组中未观察到这一现象。结论 靶点处电刺激后检测的FFR数值在消融前和消融后即刻差异显著,FFR压力导丝监测有望成为指导RDN的一种新手段,但其有效性及机制尚需进一步验证。 |
| 关键词: 经皮肾动脉交感神经消融术 血流储备分数 难治性高血压 |
| DOI：10.16781/j.0258-879x.2016.05.0622 |
| 投稿时间：2015-08-12修订日期：2016-01-19 |
| 基金项目:上海市普陀区卫生系统自主创新科研资助项目,上海市卫生和计划生育委员会重点项目(20134003). |
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| Renal sympathetic denervation guided by monitoring fractional flow reserve with pressure guide wire in pigs |
| XU You-long,LIU Zong-jun,JIN Hui-gen,CHEN Chen,XU San-bin,GAO Jun-qing,YAN Peng-yong,ZHANG Wen-quan,WANG Ming-yu,SHEN Jun* |
(Department of Cardiology, Putuo Hospital Affilated to Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China
*Corresponding author) |
| Abstract: |
| Objective To explore the feasibility of the catheter-based renal sympathetic denervation (RDN) guided by monitoring fractional flow reserve (FFR) with pressure guide wire. Methods Eleven minipigs were allocated into RDN group (n=8) and sham operation group (n=3). Before ablation, the angiography of bilateral renal arteries was conducted. Ablation catheter and FFR pressure guide wire were implanted in the renal arteries guided by 7F guided catheter. Then renal arteries were observed by X-ray. The FFR value (renal artery pressure/aortic pressure) was monitored by electric stimulation (20 Hz). When the FFR value had significant change, the target was to be ablated (50℃, 10 W, 60 s). The ablation was considered effective once there was no change of the above indicators after a second stimulation immediately following ablation. Results Renal artery ablation was successfully completed in all the 8 pigs of RDN group. FFR values were monitored before and after ablation, and the results showed that the FFR values were significantly decreased upon stimulation before RDN (0.73±0.07 vs 0.98±0.02, P<0.01), and the FFR values were almost unchanged immediately after ablation (0.97±0.03 vs 0.95±0.02, P=0.25), which was not observed in the sham operation group. Conclusion There is significant difference in the FFR values of the target following stimulation before and after RDN. The FFR pressure guide wire-mediated target ablation may become a new operation mode, with its effectiveness and mechanism needed to be further verified. |
| Key words: renal sympathetic denervation fractional flow reserve resistant hypertension |
