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目的肾血管性高血压是我国常见的一种继发性高血压,药物治疗效果差,作者采用经皮穿刺肾动脉腔内球囊成形术(PTRA)对52例次大动脉炎所致72支狭窄肾动脉进行治疗以探讨其临床应用价值并进行长期随访。方法在X线引导下,采用Seldinger氏穿刺技术将球囊导管送入狭窄肾动脉腔内充盈膨胀球囊,对狭窄病变施于机械性压力使之扩张开通,恢复肾血流灌注。进行长期随访,定期检查血压、肾脏超声及血尿素氮、肌酐、尿常规,以了解肾脏形态和功能。结果52例次72支狭窄肾动脉开通前后直径平均增加(4.1±1.3)mm,P<0.01(t=12.36)。61支动脉开通前后动脉压差平均降低(11±54)mmHg,P<0.01(t=8.37)。肢体血压:扩张前后右上臂卧位血压平均下降(41±17/24±17)mmHg,[P<0.01(t=8.12)/P<0.05(t=4.16)]。52例次(51例)失访20例,31例患者随访1～11年,平均(6.3±2.0)年,血压较术后平均下降(1.5±20/4±11)mmHg(P>0.5/P>0.5)。结论PTRA治疗大动脉炎所致肾血管性高血压是一种简便、安全、疗效可靠、具可重复性且再狭窄发生率较低的方法。对符合适应证者有条件的医院应将其列为首选疗法。
Objective Renal vasoconstriction hypertension (Hypertension) is a common type of secondary hypertension in our country. The effect of drug therapy is poor. The authors used percutaneous transluminal renal artery balloon angioplasty (PTRA) Renal artery treatment to explore its clinical value and long-term follow-up. Methods Under the guidance of X-ray, Seldinger’s technique was used to deliver the balloon catheter into the stenosed renal artery to inflate and inflate the balloon. The stenotic lesion was applied to mechanical pressure to dilate and open and to restore the renal perfusion. Long-term follow-up, regular examination of blood pressure, renal ultrasound and blood urea nitrogen, creatinine, urine routine to understand kidney morphology and function. Results The diameter of 72 stenosis renal arteries increased an average of 4.1 ± 1.3 mm in 52 cases (P <0.01) (t = 12.36). The mean arterial pressure drop of 61 arteries was reduced (11 ± 54) mmHg on average (P <0.01) (t = 8.37). Blood pressure of the limbs: The average BP of the right upper arm was decreased by 41 ± 17/24 ± 17 mmHg before and after dilation [P <0.01 (t = 8.12) / P <0.05 (t = 4.16)]. Fifty-two cases (51 cases) were lost to follow-up. Twenty-one patients were followed up for 1-11 years with an average of 6.3 ± 2.0 years. Blood pressure decreased by 1.5 ± 20/4 ± 11 mmHg on average (P> P> 0.5). Conclusions PTRA is a simple, safe, reliable, and reproducible method for the treatment of renovascular hypertension due to aortitis. Hospitals eligible for indications should be listed as the preferred therapy.