肾脏交感神经消融术治疗顽固性高血压的研究进展

原发性高血压是人数最多的心血管疾病之一。现在普遍认为,其发病机制是多因素的,因此治疗方法也应该针对病理生理的多个方面。目前,尽管多种抗高血压药物联合的治疗策略取得了良好的临床效果,但仍有部分顽固性高血压的患者无法达到目标血压。近年来,基于充分的动物实验研究和受惠于医疗器械技术的进步,一种新的使用射频导管通过微创介入途径有选择性地破坏肾交感神经从而降低血压的方法脱颖而出。在此,我们对这项技术的理论基础,临床试验结果以及发展趋势进行简单探讨。     

肾动脉交感神经射频消融术器械相关研究进展

肾动脉交感神经射频消融术具有显著的降压效果和良好的安全性,为顽固性高血压治疗提供了一种新方法。近年来,肾动脉交感神经射频消融术的射频消融装置层出不穷,各具特色,现将5种常见的肾动脉交感神经射频消融术器械及其临床研究进行综述。     

肾脏交感神经射频消融术治疗顽固性高血压的研究现状与展望

顽固性高血压是指临床上经过使用包括利尿剂在内的、足量且合理的3种或以上抗高血压药物治疗,血压仍未能控制在140/90 mm Hg以下目标值,对于患有糖尿病或肾脏疾病者未能降至130/80 mm Hg以下的高血压。顽固性高血压治疗棘手,预后差,为困扰当今医学界的一大难题。近年来有澳大利亚学者Krum等采用经皮导管肾脏交感神经射频消融术治疗顽固性高血压取得了初步成就,且实验正在向随机、多中心、大样本量标准深化,为顽固性高血压的治疗提供了一条新思路。现将对肾脏交感神经射频消融治疗在顽固性高血压治疗中的研究现状做一综述。     

肾脏交感神经消融术治疗顽固性高血压

高血压病是全球性的主要健康问题,因“高发病率、高致残率、高致死率”而引起关注。经过合理的生活方式调节及药物治疗,仍有部分患者血压难以控制。经导管肾脏交感神经消融术为顽固性高血压患者的治疗提供了新的选择。本文着重介绍肾脏交感神经消融术的理论基础、临床试验、有效性、安全性及应用前景。     

经导管肾去交感神经射频消融术

<正>近年来经导管肾去交感神经射频消融术(catheter-based renal sympathetic denervation,CRSD)成为治疗顽固性高血压的热点,大量基础以及临床研究表明肾脏去交感化可在一定程度上控制高血压。早在上世纪40年代即有外科切除内脏神经治疗难控制性高血压的研究,通过切除胸腰     

经导管肾交感神经射频消融术治疗顽固性高血压疗效及安全性的Meta分析

目的系统评价经导管肾交感神经射频消融术治疗顽固性高血压的疗效和安全性。方法检索Cochrane Library、PubMed、EM base、CNKI、VIP和万方等数据库,两名独立研究者按纳入排除标准选择文献、提取资料,采用Rev Man5.2软件进行数据处理和分析。结果纳入20篇文献,共2 294例患者。Meta分析结果显示:治疗组较对照组,术后第3、6个月收缩压及舒张压均明显降低,经导管肾交感神经射频消融术疗效优于单用药物治疗组(P<0.01)。在自身对照研究中1 152例,患者治疗术后第3、6个月同样显示降压效果良好(P<0.01)。手术无反应率较低,术后并发症较少。结论经导管肾交感神经射频消融术治疗顽固性高血压的疗效明显,安全性较高。但鉴于纳入研究质量不高,结论需更高质量、大样本的随机对照试验进一步证实。     

肾脏交感神经射频消融术治疗顽固性高血压的研究进展

<正>高血压是全球性的健康问题,是冠心病和脑卒中的主要危险因素,对心血管和肾脏疾病的发病率和死亡率有显著影响。血压的高低与心血管疾病(脑卒中、心肌梗死、心力衰竭)、肾脏疾病的死亡率呈正相关。有研究显示,血压水平与心血管风险存在线性关系,血压每升高20/10mm Hg(1mm Hg=0.133kPa),心血管疾病的死亡率增加1倍。全球每年约710万人死于高血压。在美国,每3个人约有1     

经皮肾去交感神经导管射频消融术的临床研究进展

经皮肾去交感神经导管射频消融术(RSD)是一种新的非药物微创介入治疗顽固性高血压的方法。近年临床研究表明RSD可有效治疗慢性交感神经激活引起的顽固性高血压及相关心血管疾病,如糖耐量异常、心室肥厚、心房颤动和室性心律失常、呼吸睡眠暂停、动脉硬化和慢性心肾功能不全等。主要原理经肾动脉导管消融去除其周围部分传入和传出神经,通过下丘脑中枢神经反馈机制,减少肾脏局部和全身去甲肾上腺素溢出,治疗相关疾病具有广泛应用前景,可望成为心血管疾病上游革命性治疗措施。     

肾交感神经消融术治疗高血压的进展及问题

尽管目前已经有众多的降血压药物应用于高血压的治疗,但是高血压的控制仍不尽如人意。由于高血压的高患病率及靶器官的损害,其仍然是影响公众健康的重大问题。近年来出现了一种治疗高血压的新技术———肾交感神经消融术,已部分应用于临床,但仍有一些问题限制该技术的广泛推广。     

Renal Sympathetic Denervation for Resistant Hypertension

Resistant hypertension is an increasingly prevalent health problem associated with important adverse cardiovascular outcomes. The pathophysiology that underlies this condition involves increased function of both the sympathetic nervous system and the renin–angiotensin II–aldosterone system. A crucial link between these 2 systems is the web of sympathetic fibres that course within the adventitia of the renal arteries. These nerves can be targeted by applying radiofrequency energy from the lumen of the renal arteries to renal artery walls (percutaneous renal sympathetic denervation [RSD]), an approach that has attracted great interest. This paper critically reviews the evidence supporting the use of RSD. Small studies suggest that RSD can produce dramatic blood pressure reductions: In the randomized Symplicity HTN-2 trial of 106 patients, the mean fall in blood pressure at 6 months in patients who received the treatment was 32/12 mm Hg. However, there are limitations to the evidence for RSD in the treatment of resistant hypertension. These include the small number of patients studied; the lack of any placebo-controlled evidence; the fact that blood pressure outcomes were based on office assessments, as opposed to 24-hour ambulatory monitoring; the lack of longer-term efficacy data; and the lack of long-term safety data. Some of these concerns are being addressed in the ongoing Renal Denervation in Patients With Uncontrolled Hypertension (Symplicity HTN-3) trial. The first percutaneous RSD system was approved by Health Canada in the spring of 2012. But until more and better-quality data are available, this procedure should generally be reserved for those patients whose resistant hypertension is truly uncontrolled.     

Renal Sympathetic Denervation for Treatment of Hypertension

Sympathetic nervous system activation of the heart, kidney and peripheral vasculature increases cardiac output, fluid retention and vascular resistance and plays an important role in acute and chronic BP elevation. Renal sympathetic denervation via a percutaneous radiofrequency catheter based approach is a safe and effective procedure that lowers BP in patients with resistant hypertension. Exploratory studies in patients with resistant hypertension and a variety of comorbidities, including insulin resistance/metabolic syndrome, obstructive sleep apnea and the polycystic ovary syndrome, have shown benefit of renal denervation in attenuating the severity of the comorbid conditions, as well as reducing BP. However, more studies are needed to further address the long term effects of renal denervation and its safety and effectiveness in other disease states such as congestive heart failure.