| 摘要: |
| 目的 观察5 F微孔灌注导管在经皮肾动脉去交感神经消融术（RDN）治疗顽固性高血压中的临床效果。方法 选取2013年1月至2015年12月在我院接受RDN治疗的顽固性高血压患者30例作为研究对象，采用随机信封法将患者分为普通导管消融组和微孔灌注导管消融组，每组15例。普通导管消融组使用5 F温控消融导管，微孔灌注导管消融组使用头端带小侧孔的5 F微孔灌注导管，标测及消融时用冷盐水灌注。所有患者术后随访9个月，比较两组患者的术前及随访期间诊室血压、24 h动态血压、血生物化学指标和心脏功能。结果 所有患者均成功接受RDN治疗。随访期间，微孔灌注导管消融组24 h动态血压收缩压下降值较普通导管消融组更明显[（34.67±13.02）mmHg vs（17.00±16.74）mmHg，P<0.01；1 mmHg=0.133 kPa]；微孔灌注导管消融组24 h动态血压舒张压明显下降，与普通导管消融组比较差异有统计学意义[（81.20±7.15）mmHg vs（87.60±8.17）mmHg，P<0.05]。微孔灌注导管消融组随访期间服用降压药物的种类较普通导管消融组有减少的趋势，尤其在利尿剂的使用方面，微孔灌注导管消融组服用利尿剂的比例低于与普通导管消融组（P<0.05）。在手术消融中微孔灌注导管消融组可显著降低导管消融时的温度（P<0.001），获得更大的释放能量（P<0.05），阻抗下降幅度也较普通导管消融组更大（P<0.05）。随访过程中两组患者均未出现低血压晕厥及黑矇，未出现肾功能恶化的表现。结论 5 F微孔灌注消融导管是一种安全有效的肾动脉消融导管，在RDN治疗顽固性高血压中，其在降低收缩压及减少利尿剂的使用方面较普通消融导管更具优势。 |
| 关键词: 肾去神经化 肾去交感神经消融术 灌注导管 高血压 |
| DOI：10.16781/j.0258-879x.2019.11.1263 |
| 投稿时间：2019-06-05修订日期：2019-09-24 |
| 基金项目:上海中医药大学附属普陀医院培英计划（2016013B）. |
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| Renal sympathetic denervation for treatment of resistant hypertension using a 5 F microtube-irrigated ablation catheter |
| ZHANG Hong,LI Ling-yan,Lü Tian-jiao,ZHANG Hua,DENG Wei-ming,DUAN Qiu-xia,GAO Jun-qing,LIU Zong-jun* |
(Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China
*Corresponding author) |
| Abstract: |
| Objective To observe the effectiveness of catheter-based renal sympathetic denervation (RDN) for reducing blood pressure in patients with resistant hypertension using a 5 F microtube-irrigated ablation catheter. Methods Thirty patients with resistant hypertension received RDN between January 2013 and December 2015. They were randomly divided into two groups:general ablation catheter group and microtube-irrigated ablation catheter group, with 15 cases in each group. 5 F temperature-controlled catheter was used in the general ablation catheter group. 5 F microtube-irrigated ablation catheter (microtubes at the head) was used in the microtube-irrigated ablation catheter group. Cold saline was irrigated for mapping and ablation. All patients were followed up for 9 months. Clinic blood pressure, 24 h ambulatory blood pressure, biochemical tests and cardiac function were measured at baseline and during follow-up. Results RDN was successfully performed in all patients. At the 9-month follow-up, the decrease of 24 h ambulatory systolic blood pressure (SBP) in the microtube-irrigated ablation catheter group was more obvious than that in the general ablation catheter group ([34.67±13.02] mmHg vs[17.00±16.74] mmHg, P<0.01; 1 mmHg=0.133 kPa). The 24 h ambulatory diastolic blood pressure (DBP) in the microtube-irrigated ablation catheter group was significantly lower than that in the general ablation catheter group ([81.20±7.15] mmHg vs (87.60±8.17) mmHg, P<0.05). There was a decreased trend in the use of antihypertensive drugs in the microtube-irrigated ablation catheter group as compared with the general ablation catheter group, particularly in the use of diuretics (P<0.05). During the operation, the microtube-irrigated ablation catheter group had a significantly lower catheter temperature (P<0.001), greater energy (P<0.05), and greater decrease in impedance than the general ablation catheter group (P<0.05). No syncope or amaurosis caused by hypotension, or deterioration of renal function occurred in either group. Conclusion 5 F microtube-irrigated ablation catheter is a safe and effective device during renal artery ablation. It has more advantages than general ablation catheter in reducing SBP and diuretic use in the treatment of resistant hypertension. |
| Key words: renal denervation renal sympathetic denervation irrigated ablation catheter hypertension |
