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目的对动脉硬化性肾动脉狭窄(ARAS)患者围手术期高血压及肾功能病情变化进行总结,判断外科和介入技术的治疗疗效。方法 2006年8月至2010年5月共80例肾动脉狭窄患者(共108条肾动脉病变)为研究对象,男女比例为1.8∶1,平均年龄(64.8±11.1)岁,经选择性肾动脉造影确诊肾动脉狭窄及狭窄程度,其中单侧病变52例,双侧病变28例,肾动脉轻中度狭窄(50%～69%)20条,重度狭窄(70%～99%)82条,肾动脉闭塞6条。行支架成形术67例71条肾动脉,单纯球囊成形术3例5条肾动脉,开放手术3例3条肾动脉,药物治疗7例9条肾动脉。结果全部手术治疗均顺利完成,总体肾功能获益率38.4%,高血压治疗有效率73.9%。术前血压(152.93±23.61)/(80.17±13.85)mm Hg,术后血压(134.76±16.42)/(71.53±13.85)mm Hg,差异有统计学意义(P=0.000),对比肌酐、尿素氮、肾小球滤过率及口服降压药种类,术前、术后差异无统计学意义。对比双侧ARAS解除一侧狭窄与单侧ARAS解除狭窄后一周疗效,肾小球滤过率差异有统计学意义(P=0.038)。结论外科和介入技术对改善ARAS患者高血压具有较明确的意义;双侧ARAS患者单侧治疗后肾小球滤过增加优于单侧ARAS患者,说明外科和介入治疗对维持肾功能有益。
Objective To summarize the changes of perioperative hypertension and renal function in patients with arteriosclerotic renal artery stenosis (ARAS) and to evaluate the therapeutic efficacy of surgical and interventional techniques. Methods A total of 80 patients with renal artery stenosis (total of 108 renal artery lesions) from August 2006 to May 2010 were enrolled in this study. The male-to-female ratio was 1.8: 1, with a mean age of (64.8 ± 11.1) years. Angiography confirmed renal artery stenosis and stenosis, of which 52 cases of unilateral lesions, bilateral lesions in 28 cases, mild to moderate renal artery stenosis (50% to 69%) 20 severe stenosis (70% to 99%) 82, Renal artery occlusion 6. Sixty-seven cases of 71 renal arteries, three balloons of 5 cases of simple balloon angioplasty, 3 cases of renal artery were treated with open surgery, and 7 cases of 9 cases of renal arteries were treated with stent-graft. Results All the surgeries were successfully completed. The overall benefit rate of renal function was 38.4% and that of hypertension treatment was 73.9%. Preoperative blood pressure (152.93 ± 23.61) / (80.17 ± 13.85) mm Hg, postoperative blood pressure (134.76 ± 16.42) / (71.53 ± 13.85) mm Hg, the difference was statistically significant (P = 0.000), creatinine, , Glomerular filtration rate and oral antihypertensive drugs, preoperative and postoperative differences were not statistically significant. The difference of glomerular filtration rate between two groups was statistically significant (P = 0.038). Conclusions Surgical and interventional techniques are more effective in improving hypertension in patients with ARAS. The increase of glomerular filtration rate after unilateral therapy in patients with bilateral ARAS is superior to those in patients with unilateral ARAS, which shows that surgical and interventional therapy are beneficial to maintain renal function.