HIFU治疗难治性高血压的安全性、可行性和影响因素研究

发布时间：2018-02-04 02:01

本文关键词： 高强度聚焦超声难治性高血压安全性可行性影响因素　出处：《重庆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景交感神经的过度激活一直被认为是高血压发病和维持的重要因素,近年来经导管射频消融肾去交感神经术(renal denervation,RDN)可能是难治性高血压(resistant hypertension,RH)的一种治疗方式,但其存在介入操作相关并发症和肾动脉损伤等弊端。高强度聚焦超声(high intensity focused ultrasound,HIFU)作为一种新的无创消融治疗手段,其疗效在临床实践中已被证实。HIFU应用已经扩展到心血管领域,已有HIFU成功消融犬模型肾交感神经的报道。目的本文评价临床上HIFU技术无创消融肾交感神经治疗RH的安全性和可行性;探讨HIFU治疗RH的影响因素,便于改进临床治疗方案。方法对40例RH患者行HIFU去肾交感神经术治疗,术中在彩色多普勒超声(CDFI)引导下找出肾动脉长轴的最佳消融层面。分别取每侧肾动脉近段、中段和肾门前段确定5~6个离散的靶点纵向螺旋分布覆盖肾动脉的4个象限,靶点的纵向间隔约5 mm。每个点分别以功率(200~300)W×2 s声能消融,平均每个点重复50次,每次间隔2 s。所有患者两侧肾动脉都接受治疗。治疗后随访患者6个月,评估术中及术后不良反应及并发症情况,术后血压下降效果、降压药物种类、肾动脉收缩期流速峰值和肾功能情况。根据血压下降幅度分为显效组和有效组,比较两组之间腹壁厚度、辐照时间、辐照强度等相关因素。结果1.40例患者均完成手术,治疗中主要不适为治疗区疼痛,一般在术后24 h内缓解。术后不良反应均在SIR-A~B级,无一例SIR-C~F级不良反应发生。2.术后患者左、右肾动脉收缩期流速峰值较术前无差异(P=0.635,P=0.688)。术后患者随访1、6个月血尿素氮(BUN)、血肌酐(s Cr)、肾小球滤过率(e GFR)较基线无统计学差异(P=0.772,P=0.652,P=0.366)。3.术后随访1、3、6个月较基线诊室收缩压下降21.5、23.3、22.4mm Hg(P=0.000),诊室舒张压下降11.1、12.9、12.0 mm Hg(P=0.000);24 h动态收缩压下降13.6、15.2、14.3 mm Hg(P=0.000),24 h动态收缩压下降5.5、6.0、4.4 mm Hg(P=0.000);药物种类下降0.8、0.9、1.0种(P=0.000)。4.显效组和有效组在年龄、身高、体重、辐照时间、辐照强度没有差异,而腹壁厚度差异有统计学意义(P0.05)。结论HIFU近期治疗难治性高血压是安全和可行的,但仍需深入及长期安全性、有效性探索。腹壁厚度是影响HIFU治疗RH的临床因素,腹壁厚度较薄的患者术后疗效较好。
[Abstract]:Background the excessive activation of sympathetic nerve has been considered as an important factor in the pathogenesis and maintenance of hypertension. In recent years renal denervation has been ablated by radiofrequency catheter ablation. RDN may be a treatment for refractory hypertension- resistant RHs. However, there were complications associated with interventional procedures and renal artery injury. High intensity focused ultrasound (HIFU) was associated with high intensity focused ultrasound. HIFU) as a new non-invasive ablation therapy, its efficacy has been confirmed in clinical practice. HIFU has been extended to the field of cardiovascular. The successful ablation of renal sympathetic nerve in canine model by HIFU has been reported. Objective to evaluate the safety and feasibility of noninvasive ablation of renal sympathetic nerve by HIFU. To explore the influencing factors of HIFU in the treatment of RH and to improve the clinical treatment methods 40 patients with RH were treated with HIFU. The optimal ablation plane of the long axis of renal artery was found under the guidance of CDFI. The proximal segments of each renal artery were taken respectively. The longitudinal spiral distribution of 5 ~ 6 discrete targets was determined to cover the 4 quadrants of renal artery in the middle and anterior segments of the kidney. The longitudinal interval of the target was about 5 mm. each spot was ablated with 300 W 脳 2 s sound energy, and each point was repeated 50 times on average. The patients were followed up for 6 months after treatment to evaluate the adverse reactions and complications during and after operation, the effect of lowering blood pressure and the kinds of antihypertensive drugs. The peak systolic velocity and renal function of renal artery were divided into two groups according to the decrease of blood pressure. The thickness of abdominal wall and irradiation time were compared between the two groups. Results 1.The main discomfort in the treatment was pain in the treatment area, which was generally relieved within 24 hours after operation. The adverse reactions were in the SIR-A~B grade. There was no SIR-C~F grade adverse reaction. 2. The peak systolic velocity of left and right renal artery was not different from that of preoperation. The patients were followed up 1. There was no significant difference in blood urea nitrogen bun, creatinine creatinine, glomerular filtration rate and glomerular filtration rate between 6 months and baseline. The systolic blood pressure (SBP) in 6 months was lower than that in the baseline diagnosis room by 21.5 ~ 23.3mm / 22.4 mm / g P0. 000). The diastolic blood pressure decreased by 11.1U 12.9mm / 12.0mm / g P0. 000mm; The dynamic systolic blood pressure decreased by 13.6g / 15.2mm / 14.3 mm / kg / min for 24 h, and the dynamic systolic blood pressure decreased by 5.5U / L at 24 h / h. 4.4mm Hgfus (0.000mm); There was no difference in age, height, weight, irradiation time and radiation intensity between the effective group and the effective group. The difference of abdominal wall thickness was statistically significant (P 0.05). Conclusion it is safe and feasible to treat refractory hypertension in the near future with HIFU, but it still needs to be further and long-term safe. The thickness of abdominal wall is a clinical factor affecting the treatment of RH by HIFU. The patients with thinner thickness of abdominal wall have better effect after operation.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1

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