高频电刺激指导肾动脉射频消融的实验研究

发布时间：2018-02-21 11:02

本文关键词： 肾交感神经高频电刺激射频消融　出处：《中国病理生理杂志》2016年10期 　论文类型：期刊论文

【摘要】：目的:用电刺激的方法指导肾脏去神经术(renal denervation,RDN)中射频消融靶点的选择,同时比较电刺激与射频消融时血压变化的异同。方法:成年健康昆明犬6只,行肾动脉造影排除肾动脉畸形后,每侧肾动脉从远段开始,由远及近选择数个位点进行电刺激并消融。连续记录术中血压的变化,术后通过软件分析血压的变化情况。采用常规HE和Masson染色观察肾动脉壁结构及其周围组织;采用酪氨酸羟化酶(tyrosine hydroxylase,TH)免疫组化染色观察消融后肾动脉去神经效果。结果:本实验中刺激/消融位点共计50个,其中对电刺激有反应的位点占34%,无反应位点占66%。对有反应位点进行120 s电刺激时,其收缩压按每20 s分段与基线血压相比分别变化(0.34±3.38)、(0.41±3.04)、(10.47±5.73)、(13.27±3.63)、(10.17±1.87)和(0.78±1.87)mm Hg;将120 s连续消融时的收缩压数据同样按每20 s与基线血压相比,变化分别为(0.88±3.44)、(-1.64±3.47)、(13.17±3.12)、(12.82±3.21)、(9.50±2.68)和(-6.09±2.21)mm Hg。无反应位点进行电刺激和射频消融时均无明显血压升高。组织病理学检查显示,有反应位点肾动脉神经面积为(0.51±0.28)mm~2,无反应位点处为(0.09±0.06)mm~2,差异有统计学显著性(P0.01);免疫组化染色表明消融部位神经TH的表达显著低于未消融部位(P0.01)。结论:高频电刺激可以标测肾交感神经,且电刺激指导下的射频消融能对肾动脉交感神经造成有效损伤。
[Abstract]:Objective: to guide the selection of radiofrequency ablation targets in renal deneration RDNs by electrical stimulation, and to compare the changes of blood pressure between electrical stimulation and radiofrequency ablation. After renal arteriography was performed to exclude the renal artery malformation, each renal artery was stimulated and ablated by electric stimulation from the distal segment, and the changes of blood pressure during the operation were recorded continuously. The changes of blood pressure were analyzed by software after operation. The wall structure of renal artery and its surrounding tissues were observed by routine HE and Masson staining. Tyrosine hydroxylase THH immunohistochemical staining was used to observe the effect of renal artery denervation after ablation. Results: there were 50 stimulation / ablation sites in this experiment. Of these, 34 were responsive to electrical stimulation and 66 were non-reactive. When 120 s electrical stimulation was performed on the responsive sites, The systolic blood pressure varied from 0.34 卤3.38 to 0.41 卤3.04, 10.47 卤5.73, 10.27 卤3.63, 10.17 卤1.87) and 0.78 卤1.87 mm Hg.The systolic blood pressure data during 120 s continuous ablation were also compared with the baseline blood pressure per 20 s. The changes were 0.88 卤3.44 ~ (-1.64 卤3.47) (13.17 卤3.12) and 9.50 卤2.68, respectively. There was no significant increase in blood pressure during electrical stimulation and radiofrequency ablation at the unresponsive sites. Histopathological examination showed that there was no significant increase in blood pressure. The area of nerve of renal artery with reaction site was 0.51 卤0.28 mm ~ (-2) and that of non-response site was 0.09 卤0.06 mm ~ (-2), the difference was statistically significant (P 0.01). Immunohistochemical staining showed that the expression of th in ablation area was significantly lower than that in non-ablation area (P 0.01). Conclusion: high frequency electrical stimulation can be used. Mapping the sympathetic nerves of the kidney, And radiofrequency ablation under the guidance of electrical stimulation can cause effective injury to renal artery sympathetic nerve.
【作者单位】：重庆医科大学附属第二医院心内科;
【分类号】：R454.1

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