动脉粥样硬化性肾动脉狭窄血管腔内治疗的疗效分析

发布时间：2018-04-17 18:02

本文选题：粥样硬化性肾动脉狭窄 + 经皮腔内肾动脉成形术　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的：探讨研究动脉粥样硬化性肾动脉狭窄血管腔内治疗的适应证、围手术期处理、术后支架再狭窄、治疗前后患者血压及肾功能的变化情况。资料和方法：收集分析我院2009年1月至2013年1月接受经皮腔内肾动脉成形术的32例动脉粥样硬化性肾动脉狭窄患者的临床资料，记录和评估围手术期及术后随访12-24个月(平均15个月)支架再狭窄情况、血压控制情况、抗高血压药用药情况及血肌酐值。结果：32例接受PTRA患者中，技术成功率100%，随访1年时，1例女性患者术后出现支架再狭窄，，狭窄程度为轻中度，无明显临床症状，其余31例患者未见再狭窄征象。术后1天及随访1年的血压和服用降压药物情况，分别与术前进行比较。术后1天血压较术前有明显下降（p0.05,）；随访1年时，患者收缩压由术前（155±16）mmHg降至（135±20）mmHg，(P＜0.05)；舒张压自术前（84±15）mmHg降至随访时（74±12）mmHg，(P＜0.05)。患者术后1天血压控制的临床有效率（治愈+改善）为：78.12%，术后随访1年时，患者血压控制的临床有效率为68.75%;服用的降压药物种类从PTRA前的平均2种减少到1种或停药。随访时，5例PTRA术前肾功不全的患者血清肌酐值虽然较术前水平下降，但P＞0.05，无统计学意义。结论：本研究表明血管腔内治疗ARAS术后的患者，支架再狭窄的发生率很低，对ARAS引起的继发性高血压，通过血管腔内治疗可以得到有效控制，血管腔内治疗并发症的发生率很低，同时有很高的技术成功率，是一种安全有效的方法，在临床上有较大的应用价值。然而经皮腔内肾动脉成形术对肾功能不全患者的的肾功能的保护和改善作用则有待进一步研究。
[Abstract]:Objective: to study the indications of endovascular treatment for atherosclerotic renal artery stenosis, perioperative management, stent restenosis, and the changes of blood pressure and renal function before and after treatment.Materials and methods: the clinical data of 32 patients with atherosclerotic renal artery stenosis underwent percutaneous transluminal renal angioplasty in our hospital from January 2009 to January 2013 were collected and analyzed.The restenosis of stents, blood pressure control, antihypertensive drugs and serum creatinine were recorded and evaluated during the perioperative period and follow-up for 12-24 months (mean 15 months).Results among 32 patients receiving PTRA, the technical success rate was 100%. After one year of follow-up, one female patient developed stent restenosis, the degree of stenosis was mild and moderate, and there were no obvious clinical symptoms. The other 31 patients had no signs of restenosis.Blood pressure and antihypertensive drugs were compared 1 day after operation and 1 year follow-up.1 day after operation, the blood pressure decreased significantly (P < 0.05), the systolic blood pressure (SBP) decreased from 155 卤16)mmHg to 135 卤20mm HgU (P < 0.05), and the diastolic blood pressure (DBP) decreased from 84 卤15)mmHg to 74 卤12mm HgGG at follow-up (P < 0.05).One day after operation, the clinical effective rate of blood pressure control (cure improvement) was 1: 78.12. The clinical effective rate of blood pressure control was 68.755.The type of antihypertensive drugs was reduced from 2 before PTRA to 1 or stopped.The serum creatinine levels in 5 patients with renal insufficiency before PTRA were lower than those before PTRA, but there was no statistical significance (P > 0.05).Conclusion: this study shows that the incidence of stent restenosis is very low in patients after ARAS. The secondary hypertension caused by ARAS can be effectively controlled by endovascular therapy.Endovascular therapy has a low incidence of complications and a high technical success rate. It is a safe and effective method and has great clinical application value.However, the effect of percutaneous transluminal angioplasty on renal function in patients with renal insufficiency needs further study.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.2

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