發(fā)布時(shí)間：2018-03-29 01:02

  本文選題：腎動(dòng)脈梗阻　切入點(diǎn)：支架　出處：《北京大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2017年01期

【摘要】：目的:探討腎濾過分?jǐn)?shù)(filtration fraction,FF)評(píng)價(jià)腎動(dòng)脈支架植入術(shù)對(duì)動(dòng)脈硬化性腎動(dòng)脈狹窄治療效果的意義。方法:對(duì)42例腎動(dòng)脈狹窄患者,共52條腎動(dòng)脈行腎動(dòng)脈支架植入術(shù)(percutaneous transluminal renal angioplasty and stent,PTRAS),分析患者健側(cè)腎和患側(cè)腎(分腎)腎小球?yàn)V過率(glomerular filtration rate,GFR)、分腎腎有效血漿流量(effective renal plasma flow,ERPF)和分腎腎濾過分?jǐn)?shù)的變化,術(shù)前與術(shù)后血肌酐(serum creatinine,s Cr)變化,觀察患者血壓(收縮壓)和服用降壓藥種類的變化。結(jié)果:52例腎動(dòng)脈支架植入手術(shù)全部成功,術(shù)前患側(cè)GFR明顯低于健側(cè)(t=-3.989,P=0.000),ERPF明顯低于健側(cè)(t=-4.926,P=0.000)。兩側(cè)總體FF值相當(dāng)(t=1.273,P=0.207),術(shù)后患側(cè)腎GFR有所增高,但差異無(wú)統(tǒng)計(jì)學(xué)意義(t=-1.411,P=0.164),術(shù)后患側(cè)腎ERPF明顯增高(t=-4.954,P=0.000)、FF降低(更趨近于正常值,t=3.274,P=0.002)。術(shù)后健側(cè)GFR明顯降低(t=2.569,P=0.000),ERPF明顯降低(t=3.889,P=0.001),FF無(wú)明顯變化(t=-0.758,P=0.454)。術(shù)后患側(cè)GFR低于健側(cè)(t=-3.283,P=0.002),ERPF低于健側(cè)(t=-3.351,P=0.001),但兩側(cè)FF值相當(dāng)(t=-0.361,P=0.719)。術(shù)前FF相對(duì)正常的患腎,術(shù)后FF值變化較小(t=0.799,P=0.430);術(shù)前FF明顯升高的患腎,術(shù)后FF值較術(shù)前降低(趨向正常值,t=5.299,P=0.000)�；颊咝g(shù)后總體血肌酐較前明顯下降(t=2.505,P=0.016),但對(duì)于單側(cè)腎動(dòng)脈狹窄患者,其血肌酐變化差異無(wú)統(tǒng)計(jì)學(xué)意義(t=1.228,P=0.299);而對(duì)于雙側(cè)腎動(dòng)脈狹窄患者,血肌酐較術(shù)前明顯下降(t=2.518,P=0.030),患者術(shù)后血壓(收縮壓)較術(shù)前明顯下降(t=8.945,P=0.000),服用降壓藥物種類較術(shù)前明顯減少(t=5.280,P=0.000)。結(jié)論:對(duì)于腎動(dòng)脈狹窄患者,分腎FF是了解腎缺血病理生理進(jìn)程的有益指標(biāo),術(shù)前FF顯著增高或FF相對(duì)正常,應(yīng)視為腎動(dòng)脈支架植入術(shù)的手術(shù)指征。
[Abstract]:Objective: to evaluate the effect of renal artery stent implantation in the treatment of arteriosclerotic renal artery stenosis by renal filtration fractionation FFF.Methods: 42 patients with renal artery stenosis were enrolled in this study. A total of 52 renal artery stents were implanted with transluminal renal angioplasty and stentstone to analyze the changes of glomerular filtration rate, effective renal plasma flow rate and renal filtration fraction in healthy and affected kidneys. Changes of serum creatinine Cr were observed before and after operation. Blood pressure (SBP) and kinds of antihypertensive drugs were observed. The GFR of the affected side before operation was significantly lower than that of the normal side, the GFR of the affected side was significantly lower than that of the healthy side. The total FF value of the two sides was 1.273 and 0.207, and the GFR of the affected kidney was increased after operation. However, there was no significant difference in the ERPF of the affected side after operation, but there was no significant difference between the two sides. The ERPF of the affected side was significantly higher than that of the normal value (t 3.274g / P = 0.002). The GFR of the healthy side was significantly lower than that of the healthy side (t 2.569P0.000 P0. 001F). The GFR of the affected side was lower than that of the healthy side (t = -3.283P0. 002P 0. 001), but there was no significant change in the level of the GFR of the affected side (t = 0. 758P0. 454a). After operation, the GFR of the affected side was lower than that of the healthy side (t = 3. 283P = 0. 002), but it was lower than that of the healthy side (t = 3. 351a P 0. 001), but the difference between the two sides was not significant. The relative value of FF in the side was 0.361 and 0.7190.The FF was relatively normal in the affected kidneys before operation. After operation, the FF value of patients with significantly increased FF was lower than that of the patients with preoperation (normal value was 5.299m) 0.0000.0.0000.The total serum creatinine of the patients was significantly lower than that of the patients with unilateral renal artery stenosis, but in the patients with unilateral renal artery stenosis, the total serum creatinine level was significantly lower than that of the patients with unilateral renal artery stenosis, but in the patients with unilateral renal artery stenosis, the total serum creatinine of the patients was significantly lower than that of the patients with unilateral renal artery stenosis. There was no significant difference in serum creatinine in patients with bilateral renal artery stenosis. Serum creatinine was significantly lower than that before operation, blood pressure (systolic blood pressure) was significantly lower than that before operation, blood pressure (systolic blood pressure) was significantly lower than that before operation, and the types of antihypertensive drugs were significantly lower than those before operation. Conclusion: for patients with renal artery stenosis, the blood creatinine level was significantly lower than that before operation. Renal FF is a useful index to understand the pathophysiological process of renal ischemia. The FF is significantly increased or FF is relatively normal before operation, which should be regarded as the indication of renal artery stent implantation.
【作者單位】： 北京大學(xué)第三醫(yī)院介入血管外科;
【分類號(hào)】：R692

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