肾动脉支架成形术对血压、肾功能影响及其临床应用价值

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (864 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨肾动脉支架成形术对患者血压、肾功能的影响及其应用价值。方法 140例动脉硬化性肾动脉狭窄行肾动脉支架成形术患者,其中男85例(60.7%),女55例(39.3%)。年龄47～86岁,平均(67.4±9.82)岁。共施行了152条肾动脉支架置入,12例为双侧肾动脉分期介入治疗。分析手术并发症,随访患者的血压变化、服用降压药物种类及血肌酐、尿素氮变化,超声观察支架通畅情况。结果手术成功率100%。围术期并发症:肾周血肿5例(3.3%);穿刺部位血肿5例(3.3%);术后上消化道出血2例(1.3%)。围术期死亡1例(0.6%)。随访时间24个月,高血压患者服用降压药种类从术前平均(2.9±1.2)种下降至(1.9±1.3)种(P<0.05)。总体上,高血压治愈0例,改善108例(77.1%),无效32例(22.9%)。介入手术后患者血压有所改善[术前收缩压(150.04±16.69)mmHg,术后(137.05±12.58)mmHg,P<0.001;术前舒张压(81.69±12.02)mmHg,术后(79.29±8.71)mmHg,P<0.05];133例术前肾功能正常患者术后血清肌酐尿素氮检测低于术前水平[术前血肌酐(91.63±38.06)μmol/L,术后(87.69±40.31)μmol/L,P<0.001;术前尿素氮(5.97±1.80) mmol/L,术后(5.63±1.83) mmol/L,P<0.05];7例术前肾功能不全患者介入治疗后肌酐尿素氮水平无明显改善。结论肾动脉支架成形术可以使肾动脉狭窄合并高血压患者的血压得以减轻或易于控制,同时有利于维持肾功能正常。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章

关键词 ：肾动脉狭窄, 支架成形术, 高血压, 肾功能

Abstract：Objective 140 patients with atherosclerotic renal artery stenosis who underwent stenting angioplasty were analysed retrospectively to investigate the effects on hypertension control and renal function improvement after renal artery stenting. Methods One hundred and forty patients who underwent renal artery stenting between January 2007 and June 2011 were followed up. Among 140 patients[85 men, 55 women, age ranged from 47 to 86 years, mean age (67.4±9.82) years],a total of 152 renal artery stents were implanted and 12 patients underwent bilateral renal artery stent implantation. Post-operative complication, blood pressure variation and various kinds of hypotensors, serum creatinine, and urea nitrogen were recorded. Renal artery sonography was also performed to investigate the patency after stenting. Results All operations were successful. There were 12 peri-operative complications, 5 perireal hematomas, 5 hematomas at puncture site, 2 upper gastric hemorrhage. One patient died during peri-operative period. Follow-up for 24 months. Among patients with hypertension, kinds of antihypertensive drug decreased from 2.9±1.2 preoperatively to 1.9±1.3 postoperatively (P<0.05). After operation, patients’blood pressure also decreased [(systolic pressure (150.04±16.69)mmHg pre-operatively vs (137.05±12.58)mmHg post-operatively, P<0.001; diastolic pressure (81.69±12.02)mmHg pre-operatively v.s. (79.29±8.71)mmHg post-operatively,P<0.05)].No hypertensive patient was cured, but 108(77.1%) hypertensive patient were improved, while 32(22.9%) had no effect. In patients with normal renal function, serum creatinine and urea nitrogen decreased after stenting (pre-operative sCr (91.63±38.06) μmol/L, v.s. post-operative (87.69±40.31) μmol/L, P<0.001;pre-operative BUN (5.97±1.800 mmol/L,vs post-operative (5.63±1.83) mmol/L,P<0.05). Patients complicated by pre-operative renal insufficiency did not get benefit on renal function after interventional procedure. Conclusions Renal artery stent implantation reduces high blood pressure in those who suffer from hypertension or be helpful for controlling blood pressure.In patients with normal renal function, glomerular filtration rate also is improved after implantation.

Key words： renal artery stenosis stent implantation hypertension renal function

收稿日期: 2014-02-19

ZTFLH:

R654.4

基金资助:首都医学发展科研基金(2009-2088)

作者简介: 齐一侠,硕士,主治医师,E-mail:qiyixia@126.com

引用本文:

齐一侠,陈兵,俞恒锡,谷涌泉. 肾动脉支架成形术对血压、肾功能影响及其临床应用价值[J]. 武警医学, 2014, 25(9): 908-911. QI Yixia,CHEN Bing,YU Hengxi GU Yongquan. Renal artery stenting effect on blood pressure, renal function and clinical value. Med. J. Chin. Peop. Armed Poli. Forc., 2014, 25(9): 908-911.

链接本文:

http://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 http://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2014/V25/I9/908

[1]	Grüntzig A, Vetter W, Meier B, et al. Treatment of renovascular hypertension with percutaneous transluminal dilatation of a renal-artery stenosis[J]. The Lancet, 1978, 311(8068): 801-802.
[1]	Grüntzig A, Vetter W, Meier B, et al. Treatment of renovascular hypertension with percutaneous transluminal dilatation of a renal-artery stenosis[J]. The Lancet, 1978, 311(8068): 801-802.
[2]	Dworkin L D, Cooper C J. Renal-artery stenosis[J]. New Engl J Med, 2009, 361(20): 1972-1978.
[2]	Dworkin L D, Cooper C J. Renal-artery stenosis[J]. New Engl J Med, 2009, 361(20): 1972-1978.
[3]	Shetty R, Biondi-Zoccai G G, Abbate A, et al. Percutaneous renal artery intervention versus medical therapy in patients with renal artery stenosis: a meta-analysis[J]. EuroIntervention, 2011, 7(7): 844-851.
[3]	Shetty R, Biondi-Zoccai G G, Abbate A, et al. Percutaneous renal artery intervention versus medical therapy in patients with renal artery stenosis: a meta-analysis[J]. EuroIntervention, 2011, 7(7): 844-851.
[4]	Leertouwer T C, Gussenhoven E J, Bosch J L, et al. Stent placement for renal arterial stenosis: where do we stand A meta-analysis[J]. Radiology, 2000,216(1):78-85.
[4]	Leertouwer T C, Gussenhoven E J, Bosch J L, et al. Stent placement for renal arterial stenosis: where do we stand A meta-analysis[J]. Radiology, 2000,216(1):78-85.
[5]	Kashyap V S, Schneider F, Ricco J B. Role of interventions for atherosclerotic renal artery stenoses[J]. J Vascular Surg, 2011, 54(2): 563-570.
[5]	Kashyap V S, Schneider F, Ricco J B. Role of interventions for atherosclerotic renal artery stenoses[J]. J Vascular Surg, 2011, 54(2): 563-570.
[6]	蒋雄京, 高润霖. 肾动脉支架术的临床地位和争论[J]. 中华心血管病杂志, 2010,38 (1): 3-4.
[6]	蒋雄京, 高润霖. 肾动脉支架术的临床地位和争论[J]. 中华心血管病杂志, 2010,38 (1): 3-4.
[7]	刘力生. 中国高血压防治指南2010[J]. 中华高血压杂志, 2011, 19(8): 701-708.
[7]	刘力生. 中国高血压防治指南2010[J]. 中华高血压杂志, 2011, 19(8): 701-708.
[8]	Levey A S, Coresh J. Chronic kidney disease[J]. The Lancet, 2012, 379(9811): 165-180.
[8]	Levey A S, Coresh J. Chronic kidney disease[J]. The Lancet, 2012, 379(9811): 165-180.
[9]	Murphy T P, Rundback J H, Cooper C, et al. Chronic renal ischemia: implications for cardiovascular disease risk[J]. Journal of vascular and interventional radiology, 2002, 13(12): 1187-1198.
[9]	Murphy T P, Rundback J H, Cooper C, et al. Chronic renal ischemia: implications for cardiovascular disease risk[J]. Journal of vascular and interventional radiology, 2002, 13(12): 1187-1198.
[10]	Conlon P J, Little M A, Pieper K, et al. Severity of renal vascular disease predicts mortality in patients undergoing coronary angiography[J]. Kidney international, 2001, 60(4): 1490-1497.
[11]	Kumbhani D J, Bavry A A, Harvey J E, et al. Clinical outcomes after percutaneous revascularization versus medical management in patients with significant renal artery stenosis: a meta-analysis of randomized controlled trials[J]. American heart journal, 2011, 161(3): 622-630.
[10]	Conlon P J, Little M A, Pieper K, et al. Severity of renal vascular disease predicts mortality in patients undergoing coronary angiography[J]. Kidney international, 2001, 60(4): 1490-1497.
[12]	俞恒锡, 张建, 李建新, 等. 108 例动脉硬化性肾动脉狭窄的腔内治疗临床分析[J]. 心肺血管病杂志, 2011 (6): 457-460.
[11]	Kumbhani D J, Bavry A A, Harvey J E, et al. Clinical outcomes after percutaneous revascularization versus medical management in patients with significant renal artery stenosis: a meta-analysis of randomized controlled trials[J]. American heart journal, 2011, 161(3): 622-630.
[13]	Textor S C. Atherosclerotic renal artery stenosis: overtreated but underrated?[J]. J Ame Soci Neph, 2008, 19(4): 656-659.
[12]	俞恒锡, 张建, 李建新, 等. 108 例动脉硬化性肾动脉狭窄的腔内治疗临床分析[J]. 心肺血管病杂志, 2011 (6): 457-460.
[13]	Textor S C. Atherosclerotic renal artery stenosis: overtreated but underrated?[J]. J Ame Soci Neph, 2008, 19(4): 656-659.
[14]	Kalra P A, Chrysochou C, Green D, et al. The benefit of renal artery stenting in patients with atheromatous renovascular disease and advanced chronic kidney disease[J]. Cathe Cardiov Inter, 2010, 75(1): 1-10.
[14]	Kalra P A, Chrysochou C, Green D, et al. The benefit of renal artery stenting in patients with atheromatous renovascular disease and advanced chronic kidney disease[J]. Cathe Cardiov Inter, 2010, 75(1): 1-10.
[15]	Caps M T, Perissinotto C, Zierler R E, et al. Prospective study of atherosclerotic disease progression in the renal artery[J]. Circulation, 1998, 98(25): 2866-2872.
[15]	Caps M T, Perissinotto C, Zierler R E, et al. Prospective study of atherosclerotic disease progression in the renal artery[J]. Circulation, 1998, 98(25): 2866-2872.
[16]	Edwards M S, Corriere M A. Contemporary management of atherosclerotic renovascular disease[J]. J Vasc Surg, 2009, 50(5): 1197-1210.
[16]	Edwards M S, Corriere M A. Contemporary management of atherosclerotic renovascular disease[J]. J Vasc Surg, 2009, 50(5): 1197-1210.
[17]	蒋雄京, 吴海英, 张慧敏, 等. 经皮肾动脉支架术治疗肾血管性高血压的临床结果[J]. 中国循环杂志, 2006, 21(2): 89-92.
[18]	Ivanovic V, McKusick M A, Johnson III C M, et al. Renal artery stent placement: complications at a single tertiary care center[J]. J Vascu inter radio, 2003, 14(2): 217-225.
[17]	蒋雄京, 吴海英, 张慧敏, 等. 经皮肾动脉支架术治疗肾血管性高血压的临床结果[J]. 中国循环杂志, 2006, 21(2): 89-92.
[18]	Ivanovic V, McKusick M A, Johnson III C M, et al. Renal artery stent placement: complications at a single tertiary care center[J]. J Vascu inter radio, 2003, 14(2): 217-225.