顽固性高血压

随着经济的发展和人口老龄化,世界各国高血压的患病率不断提高,顽固性高血压临床上并不少见,降压药物使用不当是主要原因之一。最佳化地使用降压药物能使大多数顽固性高血压患者的血压得到有效控制,血压控制欠佳时,必要时可采用经皮肾去交感神经导管射频消融术治疗技术,但此技术还存在一些问题和不足,需要进一步的研究证实。     

社区顽固性高血压的原因分析和治疗对策

顽固性高血压是高血压患者住院的主要原因之一。成功治疗顽固性高血压需要考虑多种因素,应在启动治疗前逐一进行评价。顽固性高血压的治疗原则强调个体化治疗、有效地控制血压、逆转血管重构、保护靶器官、降低心血管危险及并发症的发生。治疗宜采用不同类型的抗高血压药物进行联合使用,也可采用经皮导管射频消融去肾交感神经(RDN)进行治疗。     

超声引导下经皮穿刺治疗儿童外伤性肾周尿囊肿8例报告

目的探讨超声引导下经皮穿刺,中心静脉导管置入引流治疗儿童外伤性肾周尿囊肿准确率。方法回顾性分析在超声引导下8例儿童外伤性肾周尿囊肿的诊断准确率。结果 6例儿童外伤性肾周尿囊肿在超声引导下经皮穿刺中心静脉导管置入引流。治愈,2例手术治疗,随访6个月无囊肿复发,肾脏排泄功能良好。结论超声引导下经皮穿刺中心静脉导管置入引流治疗儿童外伤性肾周尿囊肿创伤小,并发症少,效果好。     

经皮肾术治疗结石梗阻性脓肾

目的评估超声引导下的利用直接穿刺型引流导管进行经皮肾造瘘术引流脓肾和微通道经皮肾碎石术治疗结石梗阻性脓肾的有效性和安全性。方法 50例结石梗阻性脓肾患者,首先超声引导下利用直接穿刺型引流导管进行经皮肾造瘘术引流脓肾,而后行经皮肾镜钬激光碎石术治疗。结果 50例患者共行55侧超声引导下经皮肾穿刺造瘘术置管引流,置管全部一次性成功,无严重出血,感染性休克,周围脏器损失等并发症。50例侧行微通道经皮肾镜碎石术治疗,单次结石清除率94%。术中、术后无严重并发症。结论超声引导下经皮肾穿刺造瘘术治疗结石梗阻性脓肾,具有操作简单、准确性及安全性好、成功率高、并发症少等优点,在此基础上进行的微通道经皮肾镜钬激光碎石术安全、有效,单次净石率高。     

经导管射频消融去肾交感神经支配术对难治性高血压患者晨峰的影响

目的探讨和总结经导管射频消融去肾交感神经支配术(RSD)对难治性高血压患者血压晨峰的影响。方法 60例难治性高血压患者随机分为对照组和治疗组,每组30例。对照组给予氢氯噻嗪片12.5 mg/d、替米沙坦片40 mg/d、硝苯地平控释片30 mg/d口服,共8周;治疗组在给予上述药物基础上行经导管射频消融去肾交感神经支配术。观察治疗前后两组患者血压晨峰变化的情况。结果对照组和治疗组均能使难治性高血压晨峰降低,对照组血压晨峰下降的幅度为收缩压(34.13±1.21)mm Hg(1 mm Hg=0.133 k Pa),舒张压(12.11±2.10)mm Hg,治疗组血压晨峰下降的幅度分别为收缩压(35.53±2.11)mm Hg,舒张压(13.31±2.30)mm Hg,两组比较差异具有统计学意义(P<0.05)。结论对于难治性高血压晨峰的控制,治疗组优于对照组,经导管射频消融去肾交感神经支配术能够有效控制难治性高血压患者的晨峰现象。     

彩超引导标准通道经皮肾镜双导管碎石清石术治疗鹿角形肾结石疗效分析

目的：探讨彩超引导经皮肾镜双导管碎石清石术治疗鹿角形肾结石的临床疗效。方法：37例鹿角形肾结石患者中,均在彩超引导下穿刺建立经皮标准肾通道,采用CYBERWAND双导管超声碎石清石治疗。结果：36例穿刺成功,1例穿刺失败,Ⅱ期穿刺成功。Ⅰ期完全取石32例,2例Ⅱ期取石,3例残留结石配合体外碎石治疗。28例单通道,9例2通道。Ⅰ期结石取净率为86.5%。手术时间为55～145min。结论：彩超引导经皮肾镜碎石取石术治疗鹿角形结石具有创伤小、清石率高、并发症少等优势,对大多数鹿角形结石可作为首选治疗方案。     

肾动脉性高血压血管成形术10例报告

<正> 经皮导管的血管成形术(PTRA)1964年首先由Dotter等开展,1974年Grunlizig采用双腔导管对肾动脉狭窄进行扩张治疗,即肾动脉狭窄成形术(PTRA)获得成功,至今已广泛应用于临床。本法取代了外科手术治疗肾血管性血压的治疗法,收到良好效果。国内报告的病例多数为大动脉炎性肾血管狭窄,我院自1981年8月～1986年5     

电子输尿管软镜手术治疗肾结石的临床疗效分析

目的:探讨分析电子输尿管软镜手术的临床疗效。方法:选取本院自2017年2月至2018年6月收治的肾结石患者100例为临床研究对象,随机分为观察组与对照组,对照组应用经皮肾镜手术治疗,观察组应用电子输尿管软镜手术,对照组:经皮肾镜手术,全麻,去截石位,肾镜置入患者输尿管导管,患者俯卧,在B超监视下选择合适手术部位进行穿刺,并建立工作通道,插入肾镜,寻找结石,使用气压弹道联合超声碎石清石系统进行碎石,术后留置肾造瘘管与双J管。术后一星期复查,并拔出肾造瘘管,一月后拔出双J管。观察组:电子输尿管软镜手术,气管插管静脉麻醉或腰硬联合麻醉,去截石位,术前两周留置双J管,通过尿道置入输尿管硬镜观察输尿管。结果:观察组患者的手术时间比较差异不显著(P0.05),观察组患者的术中出血量,下床活动时间,住院时间,结石清除率与不良反应发生率与对照组比较,差异具有统计学意义(P0.05)。结论:临床应用电子输尿管软镜手术治疗肾结石患者,安全可靠,临床疗效显著,值得在临床进一步推广应用。     

经皮肾镜取石术治疗肾切开取石术后复发或残留肾结石的疗效及安全性分析

目的:对治疗肾切开取石术后复发或者残留肾结石使用经皮肾镜取石术的实际效果进行研究。方法:选择2016年3月～2017年3月间在我院治疗的肾切开取石术后复发或者残留肾结石患者作为研究对象,对所有患者使用经皮肾镜取石术进行治疗,其中6例双导管碎石、22例气压弹道联合超声碎石以及12例气压弹道碎石。结果:所有患者均成功通过1期手术,其中28例单通道取石、7例双通道取石、5例三通道取石,手术出血量(135.64±2.93)ml,手术时间(73.14±1.28)min,住院时间(9.54±1.32)d。结论:在治疗肾切开取石术后复发或者残留肾结石使用经皮肾镜取石术具有显著的效果,对患者的创伤较小,恢复更快,更具安全性,在临床治疗中值得推广应用。     

微创经皮肾镜与经皮肾镜治疗上尿路结石的临床分析

目的分析研究微创经皮肾镜与经皮肾镜治疗上尿路结石的临床效果。方法 64例上尿路结石患者,均分为两组,甲组采用微创经皮肾镜实施碎石治疗,乙组采用标准通道经皮肾镜碎石治疗,对比两组患者的治疗效果。结果甲组出血率、出血量少于乙组,P<0.05比较有差异有统计学意义;两组结石清除率无明显差异,P>0.05比较无差异无统计学意义。结论标准通道经皮肾镜以及微创经皮肾镜均是有效治疗上尿路结石的方法,标准通道经皮肾镜碎石率稍高于微创经皮肾镜,微创治疗的出血情况少于标准通道经皮肾镜手术。     

Importance of the sympathetic nervous system in the development of renal hypertension in the rat

1. Chemical sympathectomy with 6-hydroxydopamine (6-OHDA) prevented the development of renal hypertension in 80% of weanling male rats of the C.F. strain.2. Adult male rats treated with 6-OHDA developed hypertension on bilateral clamping of the renal arteries.3. Demedullation of the adrenal glands followed by 6-OHDA treatment in adult rats prevented the development of hypertension in 75% of them.4. Weanling rats treated with 6-OHDA did not have any measurable catecholamines in their hearts up to 72-78 days after treatment.5. Unlike the weanling rats, the hearts of adult rats (demedullated or with intact medulla) showed significant refilling (40-50%) of catecholamine stores 60 days after 6-OHDA treatment.6. It is concluded that the functional sympathetic nervous system is important in the development of renal hypertension in the rat.     

New developments in the diagnosis and management of resistant hypertension

Arterial hypertension is a well-known disease with a worldwide high prevalence and impaired prognosis with respect to normotensive subjects, due to increased cardiovascular mortality and morbidity. Blood pressure levels over range can be successfully controlled with adequate treatment, but more than 10% of hypertensive people have their blood pressure uncontrolled despite a therapeutic regimen of 3 or more antihypertensive drugs. These patients, named to have resistant hypertension, have a worse cardiovascular prognosis than controlled hypertensive subjects. Twenty-four hour-ambulatory blood pressure monitoring (ABPM) reveals that at least one third of these patients have indeed white-coat resistant hypertension, a rather more benign entity. In view of this evidence, performance of 24 h-ABPM is mandatory and to document the occurrence of subclinical target organ damage in this population before the development of cardiovascular disease is needed. This would help the physician to more rigorously implement adequate measures to control hypertension. On the other hand, the definition itself of the disease implies that conventional pharmacological treatment is not effective enough for these patients to reach normal blood pressure values. To treat resistant hypertensives, recent reports pay attention to the need to recover traditional treatments--either non-pharmacologic such as strict sodium diet restriction or pharmacologic such as the use of aldosterone receptor blockers--or to implement those treatments that are novelties, such as renal sympathetic nervous system ablation or carotid barorreceptors stimulation. This review focuses on outlining the current evidence about the diagnostic confirmation of resistant hypertension, the need to characterize these patients through 24 h-ABPM, to identify the presence of subclinical target organ damage, and to deal with not only classical but also novel treatment approaches for blood pressure control.     

The contribution of the sympathetic nervous system to the development and maintenance of experimental hypertension in the rat

1. Experimental hypertension in the rat, induced either by renal artery stenosis or by treatment with deoxycorticosterone acetate (DCA) developed maximally over a period of 8 weeks. In both types of hypertension the rate of development was unaffected by immunosympathectomy or by chemical sympathectomy following the administration of 6-hydroxydopamine.2. The effect of 6-hydroxydopamine on chronic renal hypertensive rats was to produce a hypotensive action of longer duration than when similarly administered to DCA-induced hypertensive or normotensive rats. Reserpine (5-10 mg/kg intraperitoneally) produced a more marked hypotensive effect on both types of hypertensive rats although it was of much shorter duration.3. It is concluded that experimental hypertension of renal origin or induced by DCA treatment can develop even though most of the sympathetic nervous system has been destroyed. The maintenance of chronic hypertension in these conditions may depend on the adrenal glands or a hormonal system as yet undetected.     

超声引导经皮肾盂造瘘治疗恶性肿瘤所致梗阻性肾功能衰竭

目的:探讨超声引导经皮肾盂造瘘治疗恶性肿瘤所致梗阻性肾功能衰竭的临床价值。方法:对2012年6月至2015年5月中山大学附属东华医院29例因恶性肿瘤导致急性梗阻性肾功能衰竭的患者予以超声引导下经皮肾盂造瘘术,观察术后疗效和并发症情况。结果:29例患者均一次性穿刺置管成功,未见明显严重并发症,术后2~7 d肾功能均有不同程度恢复,其中28例患者肾功能明显改善,1例患者肌酐及尿素氮下降不明显。结论:超声引导经皮肾盂造瘘术安全可靠,操作简单,成功率高,能有效地改善恶性肿瘤所致的肾脏功能衰竭,为延长患者生命或进行下一步治疗提供了保障,具有较高的临床实用价值。     

Renal artery disease: diagnosis and management

Renal artery stenosis (RAS) is most commonly due to either fibromuscular dysplasia or atherosclerosis. The former predominates in young women while atherosclerosis is usually encountered in individuals over the age of 55. The most common clinical manifestation of fibromuscular dysplasia is hypertension, which can frequently be cured or significantly improved with percutaneous balloon dilation. Atherosclerotic RAS may present with hypertension, renal failure (ischemic nephropathy), recurrent episodes of congestive heart failure and flash pulmonary edema or may be discovered incidentally during an imaging procedure for some other reason. Screening tests for RAS have improved considerably over the last decade. While captopril renography was utilized almost exclusively in the past, duplex ultrasound of the renal arteries or magnetic resonance angiography have replaced other modalities as the screening test of choice in many centers. Rarely does an arteriogram have to be performed for diagnostic purposes only. Management of RAS consists of three possible strategies: medical management, surgical management or percutaneous therapy with balloon angioplasty and stent implantation. The treatment of choice to control hypertension in patients with fibromuscular disease is percutaneous angioplasty. Renal artery stenting has replaced surgical revascularization for most patients with atherosclerotic disease who meet the criteria for intervention.     

中药在高血压治疗中的研究及应用

中药在高血压的治疗中的应用已经越来越受到人们的重视。本文概述了国内外用单味中药（丹参、附子、黄芪等）或复方在高血压,高血压合并其他病症（糖尿病、慢性肾功能衰竭）的治疗,以及中药与西药联合防治高血压的研究和研究;探讨中药或复方在高血压治疗中的应用价值。     

CT引导下经皮肺穿刺空洞内置中心静脉导管介入治疗耐多药空洞性肺结核

目的：探讨CT引导下经皮肺穿刺空洞内置中心静脉导管介入治疗耐多药空洞性肺结核的临床价值。方法：将56例耐多药空洞性肺结核患者随机分为介入治疗组（28例）和单纯化疗组（28例）,均用3KmHPThZV/18PaVThZ化疗方案治疗,介入治疗组采用CT引导下经皮肺穿刺空洞内置中心静脉导管介入治疗,单纯化疗组单用抗结核药物治疗,观察疗效。结果：疗程结束时,介入治疗组痰菌阴转率（82.1%）、病灶吸收率（85.7%）、空洞闭合率（57.1%）明显高于单纯化疗组的46.4%、46.4%和21.4%（P〈0.05）。两组完成疗程时痰菌阴转者经0.5～1.0年随访,介入治疗组和单纯化疗组分别复发1例和2例,复发率分别为3.6%和7.1%,两组复发率比较,差异无统计学意义（P〉0.05）。介入治疗组无严重不良反应。结论：CT引导下经皮肺穿刺空洞内置中心静脉导管介入治疗耐多药空洞性肺结核具有加速痰细菌学阴转、病灶吸收和空洞闭合的作用,可促进症状改善,提高患者的生活质量。是一种安全、有效的介入方法,且无明显的并发症及毒副反应,值得临床推广应用。     

Excretion of norepinephrine and dopamine alcoholic metabolites after 6-hydroxydopamine

Urinary excretion of 4-hydroxy-3-methoxyphenylglycol (HMPG) and 4-hydroxy-3-methoxyphenylethanol (HMPE) sulfates (HMPG-SO₄ and HMPE-SO₄) and of their two glucuronides (HMPG-Gluc) and (HMPE-Gluc) were critically studied in normal and demedullated rats after 6-hydroxy-dopamine (6-HD) treatment. 6-HD hydrobromide (25 mg/kg) was administered either intravenously (chemical sympathectomy) or intraventricularly (central sympathectomy). Demedullation did not significantly change the output of any of the above conjugated metabolites. Chemical sympathectomy significantly reduced the excretion of HMPG-SO₄ by about 40 per cent. The other metabolites we measured were not changed by chemical sympathectomy. Evidence was provided that indicated the presence in the peripheral sympathetic nervous system of nerve terminals resistant to destruction by 6-HD. These resistant nerve terminals were further shown to be involved in the production of HMPG-Gluc. Central sympathectomy fails to change the urinary excretion of the metabolites studied, including HMPG sulfate or glucuronide.     

经导管射频肾交感神经消融术在难治性高血压及其他相关疾病中的研究进展

交感神经过度兴奋不仪与难治性高血压（RH）,还与心力衰竭、胰岛素抵抗、肾功能不全和室性心律失常等疾病密切相关。经导管射频肾交感神经消融术（RSD）治疗RH及其他相芙疾病的安全性及有效性已获得肯定。本文综述绎导管RSD存RH及其他相关疾病治疗中的应用进展。     

马来酸依那普利叶酸片治疗慢性肾功能衰竭高血压的疗效观察

目的观察马来酸依那普利叶酸片治疗慢性肾功能衰竭高血压的疗效。方法选用马来酸依那普利叶酸片对120例慢性肾功能衰竭高血压患者进行治疗,治疗前后进行相关指标比较。结果经治疗后,患者在控制血压、改善肾功能、降低同型半胱氨酸氨酸水平有明显疗效。结论依那普利叶酸片治疗慢性肾功能衰竭高血压方法安全有效,改善患者预后。