背景因素 去肾交感神经支配术原理 适应症和禁忌症 技术上的考虑临床评估 并发症 展望
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去肾交感神经支配术的临床评估(2)

时间:2012-04-04 17:32来源:未知 作者:Mr.Editor
结论: 1. 原发性顽固性高血压的基于导管的去肾交感神经支配术多中心随机试验显示可以持续和显著降低顽固性高血压患者血压 2. 血压下降的程度能够预期高血压相关疾病进展的影响 3. 这项技术没有操作相关的肾功能和

结论:

1. 原发性顽固性高血压的基于导管的去肾交感神经支配术多中心随机试验显示可以持续和显著降低顽固性高血压患者血压

2. 血压下降的程度能够预期高血压相关疾病进展的影响

3. 这项技术没有操作相关的肾功能和肾动脉严重的并发症

4. 基于原发性高血压神经病生理学的这项技术革新证实了高血压病人维持血压肾神经的重要相关性

5. 去肾交感神经支配术作为辅助治疗对原发性高血压病人是获益的

       RSD的疗效是否具有广泛的适用性,尚需要进一步验证。 Krum等[17]指出, RSD理论上不仅可用于难治性高血压人群,也可用于其他交感神经过度激活的疾病,如该技术的可以应用到慢性肾病、左心室肥厚,包括收缩期和舒张期慢性心力衰竭;能否向众多早期轻度高血压人群推广该治疗尚需具有更长期随访的大规模的研究来进一步评估这种新的介入方式,但目前的结论是令人鼓舞的。

去肾交感神经支配术的其它临床研究

1. 糖代谢的研究

2. 睡眠呼吸暂停综合征的研究

3. 多囊卵巢综合征的研究

4. 心律失常研究

5.  肥胖研究

6. 慢性肾病的研究

7. 其它研究

1. Katholi RE. Renal nerves and hypertension: an update. Fed Proc 1985; 44:2846–2850.
2. Katholi RE, Winternitz SR, Oparil S. Decrease in peripheral sympathetic nervous system activity following renal denervation or unclipping in the one-kidney oneclip Goldblatt hypertensive rat. J Clin Invest 1982; 69:55–62.
3. O’Hagan KP, Thomas GD, Zambraski EJ. Renal denervation decreases blood pressure in DOCA-treated miniature swine with established hypertension. Am J Hypertens 1990; 3:62–64.
4. Kassab S, Kato T, Wilkins FC, Chen R, Hall JE, Granger JP. Renal denervation attenuates the sodium retention and hypertension associated with obesity. Hypertension 1995; 25:893–897.
5. Whitworth JA, Denton DA, Graham WF, Humphery TJ, Scoggins BA, Coghlan JP. The effect of renal denervation on ACTH-induced hypertension in sheep. Clin Exp Pharmacol Physiol 1981; 8:203–207.
6. DiBona GF. Physiology in perspective: The Wisdom of the Body. Neural control of the kidney. Am J Physiol Regul Integr Comp Physiol 2005; 289:R633–R641.
7. DiBona GF, Sawin LL. Role of renal nerves in sodium retention of cirrhosis and congestive heart failure. Am J Physiol 1991; 260:R298–R305.
8. Villarreal D, Freeman RH, Johnson RA, Simmons JC. Effects of renal denervation on postprandial sodium excretion in experimental heart failure. Am J Physiol 1994; 266:R1599–R1604.

9. Campese VM, Kogosov E. Renal afferent denervation prevents hypertension in rats with chronic renal failure. Hypertension 1995; 25:878–882.
10. Campese VM, Kogosov E, Koss M. Renal afferent denervation prevents the progression of renal disease in the renal ablation model of chronic renal failure in the rat. Am J Kidney Dis 1995; 26:861–865.
11. DiBona GF, Kopp UC. Neural control of renal function. Physiol Rev 1997; 77:75–197.
12. Norman RA Jr, Murphy WR, Dzielak DJ, Khraibi AA, Carroll RG. Role of the renal nerves in one-kidney, one clip hypertension in rats. Hypertension 1984; 6:622–626.
13. DiBona GF. Sympathetic nervous system and the kidney in hypertension. Curr Opin Nephrol Hypertens 2002; 11:197–200.
14. Campese VM. Neurogenic factors and hypertension in chronic renal failure. J Nephrol 1997; 10:184–187.

15. Ye S, Zhong H, Yanamadala V, Campese VM. Renal injury caused by intrarenal injection of phenol increases afferent and efferent renal sympathetic nerve activity. Am J Hypertens 2002; 15:717–724.
16. Joles JA, Koomans HA. Causes and consequences of increased sympathetic activity in renal disease. Hypertension 2004; 43:699–706.

17. Krum H, Schlaich M, Whitbourn R, Sobotka PA, Sadowski J, Bartus K, Kapelak B, Walton A, Sievert H, Thambar S, Abraham WT, Esler M. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. Lancet. 2009 Apr 11;373(9671):1275-81.

18. Symplicity HTN-1 Investigators. Catheter-Based Renal Sympathetic Denervation for Resistant Hypertension: Durability of Blood Pressure Reduction Out to 24 Months. Hypertension. 2011; 57: 911-917

19. Symplicity HTN-2 Investigators, Esler MD, Krum H, Sobotka PA, Schlaich MP, Schmieder RE, Böhm M. Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. Lancet. 2010 Dec 4;376(9756):1903-9.
 

 

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