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目的探讨肾交感神经射频消融术治疗高血压的适宜消融温度。方法成年健康杂种犬20只,雌雄不拘,体质量15～25 kg,建立腹主动脉缩窄型高血压模型后,随机分为治疗组(行双侧肾交感神经射频消融术)和对照组(n=10)。治疗组根据预置消融温度随机分为45℃和50℃组(n=5)。20只犬分别于建模前、建模后1(射频消融术前)、2(术后1个月)、3个月(术后2个月)监测收缩压、舒张压和平均动脉压。建模后3个月治疗组复查肾动脉造影。肾动脉行HE染色观察病理改变。结果建模后1个月,治疗组和对照组血压均显著升高(P<0.01)。射频消融术后1月治疗组收缩压显著降低(P<0.05)。射频消融术后2个月,收缩压、舒张压、平均动脉压均明显低于射频消融术前(P<0.05,P<0.01),且显著低于对照组(P<0.05,P<0.01)。治疗组复查造影未发现肾动脉狭窄及其他异常。肾动脉血管壁病理检查结果显示,50℃组血管壁损伤明显比45℃组严重。结论 45℃可以作为肾交感神经射频消融术治疗高血压的常规消融温度。
Objective To investigate the suitable ablation temperature of renal sympathetic nerve radiofrequency ablation for the treatment of hypertension. Methods Twenty adult dogs were randomly divided into treatment group (bilateral renal sympathetic nerve radiofrequency ablation) and control group (n = 20). The body weight was 15 ~ 25 kg, and the model of abdominal aorta constriction hypertension was established. n = 10). The treatment group was randomly divided into 45 ℃ and 50 ℃ groups according to the preset ablation temperature (n = 5). Twenty dogs were monitored for systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure before modeling, 1 after radiofrequency ablation (before radiofrequency ablation), 2 (1 month after surgery), and 3 months after surgery (2 months after surgery). Three months after modeling, the treatment group reviewed renal artery angiography. Renal artery was stained with HE to observe the pathological changes. Results One month after modeling, the blood pressure of the treatment group and the control group were significantly increased (P <0.01). The systolic blood pressure of the treatment group was significantly decreased after radiofrequency ablation (P <0.05). Systolic blood pressure, diastolic blood pressure and mean arterial pressure were significantly lower than those before radiofrequency ablation (P <0.05, P <0.01) and were significantly lower than those of the control group at 2 months after RFA (P <0.05, P <0.01) . Renal artery stenosis and other abnormalities were not found in the treatment group. Renal artery wall pathological examination showed that 50 ℃ group of vascular wall injury was significantly worse than the 45 ℃ group. Conclusion 45 ° C can be used as a routine ablation temperature for the treatment of hypertension by renal sympathetic nerve radiofrequency ablation.