支架置入术对肾动脉狭窄患者血压和分肾肾功能的影响

目的评价肾动脉支架置入（PARAS）的安全性及对肾动脉狭窄（RAS）血压和患侧肾肾功能的影响。方法对109例RAS患者行PTRAS。男63例（58%）,女46例（42%）。年龄18～79岁,平均为（61±5）岁。病因分别为肾动脉粥样硬化89例（81.7%）,多发性大动脉炎15例（13.7%）,肌纤维发育不良3例（2.8%）,移植术后狭窄2例（1.8%）。随访12～48个月,平均24±2个月,观察测定患者血压、分肾肾小球滤过率（SKGFR）及降压药的应用情况。结果109例149条肾动脉行PTRAS后管腔直径狭窄从74%～100%（84.2±11.8）%降至0%～25（6.5±5.3）%,管腔最小直径从0～1.6mm（1.2±0.8）mm增至4.8mm～7.5mm（5.8±0.8）mm。技术成功率98%（107/109）。2例肾动脉残留狭窄35%。无肾动脉破裂及夹层发生。收缩压由术前平均165±25mmHg降至随访时平均141±20mmHg（P〈0.01）,舒张压由术前平均95±12mmHg,降至随访时83±10mmHg。（P〈0.01）。高血压治愈13例（12%）,改善61例（56%）,无效37例（34%）,总有效率（68%）。降压药物种类由术前3.2±1.0种降至术后2.3±1.1种（P〈0.05）。SKGFR总体升高,由术前平均31±13ml/min,升至术后平均35±14ml/min,（P〈0.01）。分肾肾功能改善55例（37%）,稳定81（54%）,恶化13（9%）。PTRAS的并发症总计（11/109,10%）,5例术后发生急性肾功能不全,其中2例为可逆性。1例出现股动脉穿刺点假性动脉瘤,5例出现股动脉穿刺点出血。结论PTRAS对RAS安全有效,有助于患者控制血压,减少口服降压药,维持和改善肾功能。

Evaluation of Blood Pressure and Split-renal Function after Renal Artery Stenting in Patients with Renal Artery Stenosis

Objective To evaluate safety,blood pressure,and split-renal function after renal artery stenting in patients with renal artery stenosis（RAS）. Methods Percutaneous renal artery stent （PTRAS） was performed in 109 patients with single or bilateral renal artery stenosis （≥70%）for different etiological factor. Mean age was 61 years （range,18～79 years）,and 58%（63/109） were males. Follow-up was conducted to every patient for blood pressure,single kidney glomerular filtration rate（SKGFR）,and application of antihypertensive agents for an average of 24±2 months.Results A total of 149 stenotic renal arteries were performed PTRAS in 109 consecutive patients. After PTRAS,renal artery stenosis was decreased obviously from84.2±11.8% to 6.5±5.3%,and residual stenosis was 35% in 2 patients.The technical success was 98%（107/109）.No renal artery rupture and dissection occurred. The systolic and diastolic pressure were significantly decreased from 165±25/95±12 mmHg to 141±20/83±10 mmHg（P〈0.01）. 13（12%）patients with hypertension were cured,61（56%） were improved,37（34%） were inefficient,the total effective rate was 68%.The antihypertensive agents types were reduced from 3.2±1.0 pre-operation to 2.3±1.1 post-opertation（P〈0.05）. SKGFR rised from 31±13ml/min to 35±14ml/min（P〈0.01）. Split-renal Function was improved in 55 cases（37%）,stabilized in 81（54%）,and worsened in 13（9%）. Procedure-related complications occurred in 10% cases（11/109）,including 5 acute renal insufficiency of which 2 were reversible,1 false aneurysm,and 5 bleeding at the femoral artery puncture sites. Conclusion PTRAS is a safe and effective method for RAS that benefits the improvement and control of blood pressure,the reduction of oral antihypertensive agents,and the improvement of renal function in the patients with renal artery stenosis.