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目的分析和观察粥样硬化性肾动脉狭窄(ARAS)患者介入治疗术后的临床疗效及影响因素。资料与方法对50例动脉粥样硬化患者65支肾动脉狭窄行经皮腔内肾动脉成形术(PTRA)(包括球囊扩张术和支架置入术),术后1个月、6个月、12个月、24个月随访血压、抗高血压药用药情况、血肌酐及再狭窄情况。结果 50例患者中,术后1、6、12个月全部成功随访,但术后24个月有15例失访。技术成功率为98%,术后1个月、6个月、12个月、24个月血压分别较术前有明显下降(P<0.05),血压控制的临床有效率(治愈+改善)分别为94%、74%、64%和51%,抗高血压药由术前平均3.5种,术后1个月、6个月、12个月平均下降分别为1种、2种、3种,24个月又恢复到3.5种。血清肌酐值与基础值相比无显著差异,术后6个月肾功能改善、稳定及恶化例数分别为12例(24%)、29例(58%)和8例(16%);术后12个月肾功能稳定及恶化例数分别为39例(78%)和11例(22%);术后24个月肾功能稳定及恶化例数分别为26例(74%)和8例(16%)。术后6个月、12个月、24个月支架内再狭窄发生率分别为6.8%、15%、20%。结论 PTRA是治疗ARAS患者十分安全、有效的方法,技术成功率高,并发症发生率低,可以提高ARAS引起的继发性高血压的控制率,还可以保护和改善患者的肾功能。
Objective To analyze and observe the clinical effect and influencing factors after interventional therapy in patients with atherosclerotic renal artery stenosis (ARAS). Materials and Methods Percutaneous transrenal renal artery angioplasty (PTRA) (including balloon dilatation and stenting) was performed on 65 renal artery stenosis in 50 patients with atherosclerosis. One month, 6 months, 12 months, 24 months follow-up blood pressure, antihypertensive drug use, serum creatinine and restenosis. Results All 50 patients were followed up successfully at 1, 6 and 12 months after operation, but 15 patients were lost at 24 months after operation. The technical success rate was 98%. The blood pressure at 1 month, 6 months, 12 months and 24 months after operation were significantly lower than those before operation (P <0.05), respectively. The effective rate of blood pressure control (cure + improvement) The results showed that the antihypertensives were reduced by an average of 3.5 before surgery, 1, 2, 3 respectively at 1 month, 6 months and 12 months after operation, 24 months and recovered to 3.5 kinds. Serum creatinine values were not significantly different from baseline, and renal function was improved 6 months after surgery in 12 patients (24%), 29 patients (58%) and 8 patients (16%), respectively The number of patients with stable and worsening renal function in 12 months was 39 (78%) and 11 (22%), respectively. Twenty-four patients (74%) had stable and worsening renal function at 24 months and 8 (16%). The incidences of in-stent restenosis at 6 months, 12 months and 24 months after surgery were 6.8%, 15% and 20%, respectively. Conclusion PTRA is a safe and effective method for the treatment of patients with ARAS. The high technical success rate and low complication rate can improve ARAS-induced control rate of secondary hypertension and protect and improve renal function.