摘要
目的评价经皮肾动脉成形术血运重建对肾动脉狭窄老年高血压患者的血压、肾功能等方面中远期的影响及术后支架内再狭窄的相关因素。方法选择合并有高血压的肾动脉狭窄患者199例;经肾动脉成形术重建肾动脉血运。术后平均随访(19±11)个月,观察患者血压、降压药物、肾功能的变化,并对支架内再狭窄进行相关分析。结果 199例患者中,肾动脉成形术成功率97.5%。病变动脉管腔直径狭窄率由(73±11)%降至(12±10)%。术后随访138例患者血压下降明显,收缩压由(161±26)mm Hg(1mm Hg=0.133 kPa)降至(1 37±16)mm Hg,舒张压由(85±1 5)mm Hg降至(77±11)mm Hg,差异有统计学意义(P<0.01);口服降压药物品种明显减少,由平均(2.4±1.2)种降至(1.8±0.9)种(P<0.01);患者手术前后肌酐水平无显著差异,但对术前有肾功能不全患者估测的肾小球滤过率改善差异有统计学意义;术后24个月发生支架内再狭窄14例,非开口病变是再狭窄的危险因素。结论老年高血压肾动脉狭窄患者经皮肾动脉成形术的手术成功率高,并有助于此类患者血压的长期控制,特别是部分肾功能不全患者肾小球率过滤可能会有改善,支架内再狭窄与病变部位相关。
Objective To evaluate the changes of blood pressure and kidney function after the renal artery angioplasty and stenting in elderly patients with renal artery stenosis. Methods 199 elderly patients with renal artery stenosis and hypertension received percutaneous transluminal renal artery angioplasty/stenting（PTRAS）. Long term（19±11 months） blood pressure,serum creatinine and glomerular filtration rate were followed-up in 138 patients. Results Renal artery revascularization was successful in 97.5% of all 199 patients. The renal artery stenosis was decreased from （73±11） % to （12 ± 10）% after PTRAS. The blood pressure of 138 patients during follow-up decreased significantly, systolic pressure decreased from（161± 26） mm Hg to （137 ± 16） mm Hg and diastolic pressure decreased from（85±15） mm Hg to （77±11） mm Hg,with statistically significant difference （P 〈 0.01）. The number of anti-hypertensive drugs was significantly decreased from（2.4 ±1.2） to （1.8±0.9） （P 〈 0.01）. Serum creatinine level and glomerular filtration rate did not change significantly after the treatment. Fourteen patients presented in-stent restenosis from 1 to 24 months, and in-stent restenosis was correlated with nonostial stenoses. Conclusions Long-term blood pressure of patients with renal artery stenosis can be benefited from PTRAS, and in-stent restenosis was related to the location of renal artery stenosis.
出处
《中华老年心脑血管病杂志》
CAS
北大核心
2011年第3期227-230,共4页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
关键词
高血压
肾动脉梗阻
支架
血管成形术
抗高血压药
hypertension
renal artery obstruction
stents
angioplasty
antihypertensive agents
