经皮肾动脉介入对肾动脉狭窄患者Pickering综合征发作、血压和心功能的影响
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摘要
目的:探讨经皮肾动脉介入对肾动脉狭窄患者Pickering综合征发作、血压和心脏超声部分指标的影响。方法:80例肾动脉狭窄患者按照是否行经皮肾动脉介入治疗分为实验组(44例,经皮肾动脉介入治疗)和对照组(36例,常规药物治疗),记录两组治疗前和治疗后1年内的Picketing综合征发作次数,于治疗前及治疗后1年时评价患者的NYHA心功能分级、血压及6 min步行距离;采用超声心动图检测患者的左心室射血分数(LVEF)、二尖瓣口流速比值(E/A)、左心室舒张末容积(LVEDD)及左心室收缩末容积(LVESD)。结果:治疗后1年实验组Picketing综合征的发作次数(0次,0.00%)显著少于对照组(26次,72.22%),差异有统计学意义(P<0.05);治疗后1年实验组心功能分级改善情况显著优于对照组,差异有统计学意义(P<0.05);治疗后1年实验组LVEF、E/A、LVEDD、LVEDS、6 min步行距离及指标的改善情况显著优于对照组,差异具有统计学意义(P<0.05);治疗后1年实验组收缩压、舒张压、脉压较对照组显著降低,降压药使用种显著少于对照组,差异有统计学意义(P<0.05)。结论:经皮肾动脉介入治疗可有效控制肾动脉狭窄患者的血压,减少其Picketing综合征的发作次数,明显改善心脏功能。
Objective: To investigate the effect of percutaneous renal artery intervention on the incidence of Pickering syndrome,blood pressure and partial cardiac ultrasound indexes in patients with renal artery stenosis. Method: 80 patients with renal artery stenosis were divided into experimental group( accepting percutaneous renal artery intervention,n = 44) and control group( receiving routine drug treatment,n = 36). The two groups were continuously treated for 1 year. The attack frequency of Picketing syndrome was recorded before treatment and within 1 year after treatment,and the NYHA cardiac function grades,blood pressure and 6 min walking distance were evaluated before treatment and at 1 year after treatment,and the echocardiography was used to detect the left ventricular ejection fraction( LVEF),mitral valve velocity ratio( E/A),left ventricular end diastolic volume( LVEDD)and left ventricular end systolic volume( LVESD) in order to assess cardiac function. Result: At 1 year after treatment,the attack frequency of Picketing syndrome episodes in the experimental group( 0,0. 00%) was significantly less than that in the control group( 26 times,72. 22%)( P < 0. 05).At 1 year after treatment,the improvement of cardiac function in the experimental group was significantly better than that in the control group( P < 0. 05). At 1 year after treatment,the improvement of LVEF,E/A,LVEDD,LVEDS,6 min walking distance and indexes in the experimental group was significantly better than that in the control group( P < 0. 05). At 1 year after treatment,the levels of systolic blood pressure,diastolic blood pressure and pulse pressure in the experimental group were significantly lower than those in the control group,and the use of antihypertensive drugs was significantly less than that in the control group( P < 0. 05). Conclusions: Percutaneous renal artery interventional therapy can effectively control the blood pressure,reduce the attack frequency of Picketing syndrome and improve the cardiac function of patients with renal artery stenosis.
Objective: To investigate the effect of percutaneous renal artery intervention on the incidence of Pickering syndrome,blood pressure and partial cardiac ultrasound indexes in patients with renal artery stenosis. Method: 80 patients with renal artery stenosis were divided into experimental group( accepting percutaneous renal artery intervention,n = 44) and control group( receiving routine drug treatment,n = 36). The two groups were continuously treated for 1 year. The attack frequency of Picketing syndrome was recorded before treatment and within 1 year after treatment,and the NYHA cardiac function grades,blood pressure and 6 min walking distance were evaluated before treatment and at 1 year after treatment,and the echocardiography was used to detect the left ventricular ejection fraction( LVEF),mitral valve velocity ratio( E/A),left ventricular end diastolic volume( LVEDD)and left ventricular end systolic volume( LVESD) in order to assess cardiac function. Result: At 1 year after treatment,the attack frequency of Picketing syndrome episodes in the experimental group( 0,0. 00%) was significantly less than that in the control group( 26 times,72. 22%)( P < 0. 05).At 1 year after treatment,the improvement of cardiac function in the experimental group was significantly better than that in the control group( P < 0. 05). At 1 year after treatment,the improvement of LVEF,E/A,LVEDD,LVEDS,6 min walking distance and indexes in the experimental group was significantly better than that in the control group( P < 0. 05). At 1 year after treatment,the levels of systolic blood pressure,diastolic blood pressure and pulse pressure in the experimental group were significantly lower than those in the control group,and the use of antihypertensive drugs was significantly less than that in the control group( P < 0. 05). Conclusions: Percutaneous renal artery interventional therapy can effectively control the blood pressure,reduce the attack frequency of Picketing syndrome and improve the cardiac function of patients with renal artery stenosis.
引文
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[13]KOK H K,LEONG S,GOVENDER P,et al.Percutaneous renal artery angioplasty and stenting:indications,technique and results[J].Ir J Med Sci,2013,182(3):351-356.
[14]何景良.经皮肾动脉内球囊成形术与支架置入术对肾动脉狭窄患者术后肾动脉血流动力学影响的比较[J].中国基层医药,2013,20(4):559-560.
[15]EROL F,ARSLAN,YKSEL,et al.Determinants of iatrogenic femoral pseudoaneurysm after cardiac catheterization or percutaneous coronary intervention via the femoral artery[J].Turk Kardiyol Dern Ars,2015,43(6):513-519.
[2]李明琰,崔永生,何文凯,等.经皮肾动脉介入治疗对肾动脉狭窄患者心功能的影响[J].岭南心血管病杂志,2016,22(4):449-453.
[3]STAUB D,PARTOVI S,ZELLER T,et al.Multimarker assessment for the prediction of renal function improvement after percutaneous revascularization for renal artery stenosis[J].Cardiovasc Diagn Ther,2016,6(3):221-233.
[4]ERWIN P A,GOEL S S,GEBRESELASSIE S,et al.Restoration of renal allograft function via reduced-contrast percutaneous revascularization of transplant renal artery stenosis[J].Tex Heart Inst J,2015,42(1):80-83.
[5]周妍,郭航远,池菊芳,等.肾动脉狭窄性高血压的临床特点及经皮肾动脉介入治疗的效果分析[J].中国全科医学,2013,16(17):2042-2044.
[6]孟凡华,韩媛媛,汪浩,等.经皮肾动脉介入与药物治疗动脉粥样硬化性肾动脉狭窄有效性的Meta分析[J].中国循证心血管医学杂志,2015,7(5):587-592.
[7]RUZSA Z,TTH K,JAMBRIK Z,et al.Transradial access for renal artery intervention[J].Interv Med Appl Sci,2014,6(3):97-103.
[8]COLYER J H,RATNAYAKA K,SLACK M C,et al.Renal artery stenosis in children:therapeutic percutaneous balloon and stent angioplasty[J].Pediatr Nephrol,2014,29(6):1067-1074.
[9]沈迪,吴洁.高尿酸血症与部分动脉粥样硬化危险因素的关系[J].中南医学科学杂志,2016,44(5):591-593.
[10]赵哲维,刘昌伟.动脉粥样硬化性肾动脉狭窄介入治疗的现状与展望[J].中华医学杂志,2016,96(4):318-320.
[11]MEER M G,CRAMER M J,GRAAF Y,et al.The impact of polyvascular disease on long-term outcome in percutaneous coronary intervention patients[J].Eur J Clin Invest,2014,44(3):231-239.
[12]PRAJAPATI J S,JAIN S R,JOSHI H,et al.Response of blood pressure after percutaneous transluminal renal artery angioplasty and stenting[J].World J Cardiol,2013,5(7):247-253.
[13]KOK H K,LEONG S,GOVENDER P,et al.Percutaneous renal artery angioplasty and stenting:indications,technique and results[J].Ir J Med Sci,2013,182(3):351-356.
[14]何景良.经皮肾动脉内球囊成形术与支架置入术对肾动脉狭窄患者术后肾动脉血流动力学影响的比较[J].中国基层医药,2013,20(4):559-560.
[15]EROL F,ARSLAN,YKSEL,et al.Determinants of iatrogenic femoral pseudoaneurysm after cardiac catheterization or percutaneous coronary intervention via the femoral artery[J].Turk Kardiyol Dern Ars,2015,43(6):513-519.