优化去肾交感神经射频消融术对顽固性高血压的疗效
发布时间：2018-01-08 00:28
本文关键词：优化去肾交感神经射频消融术对顽固性高血压的疗效 出处：《四川医科大学》2015年硕士论文 论文类型：学位论文
更多相关文章： 肾交感神经 去神经射频消融术 自发性高血压大鼠 肾上腺素 去甲肾上腺素
【摘要】：背景:据2010《中国高血压防治指南》相关研究报道,我国高血压患者已过亿,且有逐年递增的趋势,约占全球高血压患者总数的五分之一,是名副其实的高血压大国。尽管目前可供选择的降压药物的种类很多,但即便给予了多种不同种类的、足够剂量的降压药物治疗后,仍有约10-20%的高血压患者血压不能达标。学术界将同时服用三种不同种类足量降压药(包括一种利尿剂)后血压仍不能达标者称为顽固性高血压患者。这类患者往往合并多重心血管危险因素,长期血压控制不佳,心脑肾并发症接踵而至,临床预后差,目前尚无有效可行的解决办法,是心血管领域临床治疗中非常棘手的难题。此外,高血压是导致冠心病、心力衰竭和心律失常的源头疾病,控制好顽固性高血压有望显著提高整体心血管疾病的防治水平。交感神经的过度激活跟高血压的发生密切相关。近些年来相关研究表明:肾交感神经的过度激活在顽固性高血压的发病机制中扮演重要角色。目的:肾交感神经的过度激活与高血压的发病机制密切相关。为了有效的控制顽固性高血压,本实验旨在探讨优化肾交感神经消融术对降低顽固性高血压的疗效。方法:按照大鼠体重编号,完全随机化分组,采用统计软件产生随机数。将30只12周龄雄性自发性高血压大鼠(shr)被随机分为shr手术组14d(n=10)、shr手术组28d(n=10)、shr假手术对照组(n=10);将30只12周龄雄性wistar-kyoto大鼠(wky)被随机分为wky手术组14d(n=10)、wky手术组28d(n=10)、wky假手术对照组(n=10);以上分组中假手术对照组于术前、术后、术后14d,术后28d分别进行检测相关指标(血压、心率、血液指标等),余下的手术组分别检测术前、术后、复查时期的血压、心率和血液指标等。所有实验组均分别采用经腹腔双侧肾动脉外膜去神经术,每侧肾动脉由近端致远端螺旋分布选4个消融点,每个点非连续消融30s,分别用2w功率进行消融术。shr手术组14d(n=10)、wky手术组14d(n=10),于术后2周复查取材;shr手术组28d(n=10)、shr假手术对照组(n=10)、wky手术组28d(n=10)、wky假手术对照组(n=10)于术后4周复查取材。所有大鼠检测以下指标:1)、使用大鼠尾智能血压计测定所有大鼠术前、术后、复查时间段安静状态下收缩压、舒张压、心率;2)、采用酶法测定大鼠血浆肌酐、尿素(术前、术后、复查);3)、采用焦酚红法测定大鼠24h尿蛋白含量,用全自动生化仪检测尿na+、k+、cl+(术前、术后、复查);4)、采用elisa试剂盒检测大鼠血浆去甲肾上腺素、肾上腺素和多巴胺含量(术前、复查);5)、采用大鼠肾动脉石蜡切片he染色比较shr大鼠和wky大鼠去神经术后肾交感神经损伤形态变化;6)、采用大鼠肾动脉石蜡切片行免疫组化染色比较shr大鼠和wky大鼠去神经术后肾交感神经阳性面积表达百分比;7)、采用大鼠肾动脉石蜡切片行movat五色套染比较shr大鼠和wky大鼠去神经术后肾动脉肌层组织内损伤情况;8)、采用he染色法显示shr大鼠和wky大鼠去神经术后肾脏病理学形态变化;9)、采用masson染色法显示shr大鼠和wky大鼠去神经术后其心肌有无纤维化改变。结果:1、shr大鼠手术组和wky大鼠手术组复查血压(收缩压、舒张压)较术前对比均有明显降低,对其心率无明显影响。2、shr大鼠和wky大鼠经去肾交感神经射频消融术后,对大鼠肾功能无明显影响。3、shr大鼠和wky大鼠经去肾交感神经射频消融术后,对大鼠尿电解质和24h尿蛋白无明显影响。4、shr大鼠手术组和wky大鼠手术组复查,血液去甲肾上腺素、肾上腺素和多巴胺含量均较术前明显降低。5、去肾交感神经射频消融术对shr和wky肾交感神经形态损伤6、去肾交感神经射频消融术能显著降低shr和wky肾交感神经7、去肾交感神经射频消融术对shr大鼠和wky大鼠肾动脉肌层组织损伤甚微。8、去肾交感神经射频消融术对SHR大鼠和WKY大鼠肾脏肾小球形态影响不明显。9、去肾交感神经射频消融术可稍缓解SHR大鼠心肌纤维化,对WKY大鼠心肌无明显影响。结论:1.采用功率2W,非连续性消融,成功构建经腹腔肾动脉去神经射频消融术降压模型;2.去神经降压的机制是通过破坏肾交感神经活性,降低交感神经递质的释放,从而降低大鼠血压;3.肾交感神经在高血压的发病中起到重要作用。
[Abstract]:Background: according to 2010< Chinese Hypertension Prevention Guide > related research reports, China has billions of dollars in hypertensive patients, and there is a rising trend, accounting for about 1/5 of the total global hypertension patients, is worthy of the name of a big country with hypertension. Though many kinds of antihypertensive drugs currently available, but even to a variety of different types of hypertension adequate drug treatment dose, there are still about 10-20% of blood pressure in patients with hypertension. The academic circles can not reach the standards will also take three different kinds of adequate antihypertensive drugs (including a diuretic) after blood pressure still can not be called refractory hypertension patients. These patients often associated with multiple cardiovascular risk factors, long-term poor control of blood pressure, cardiovascular and renal complications ensue, the prognosis is poor, there is no effective and feasible solution, is a very difficult problem in the clinical treatment of the cardiovascular system. That is the source of disease of hypertension cause coronary heart disease, heart failure and arrhythmias, good control of resistant hypertension is expected to significantly improve the overall level of prevention and treatment of cardiovascular diseases. The excessive activation of sympathetic nerve is closely related with the occurrence of hypertension. The related research shows that in recent years, the excessive activation of renal sympathetic nerves play an important role in the pathogenesis of intractable hypertension. Objective: renal sympathetic nerve activation is closely related to the pathogenesis of hypertension. In order to control hypertension effectively, this study aims to investigate the optimization of renal sympathetic nerve ablation on the clinical curative effect of refractory hypertension. Methods: according to the number of rats, completely randomized grouping, generating random numbers using statistical software. 30 only 12 week old male spontaneously hypertensive rats (SHR) were randomly divided into SHR group (14d n=10), SHR operation group, 28d (n=10) SHR hand 鏈鐓х粍(n=10);灏，
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