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目的评价经皮肾动脉成形术血运重建对肾动脉狭窄老年高血压患者的血压、肾功能等方面中远期的影响及术后支架内再狭窄的相关因素。方法选择合并有高血压的肾动脉狭窄患者199例;经肾动脉成形术重建肾动脉血运。术后平均随访(19±11)个月,观察患者血压、降压药物、肾功能的变化,并对支架内再狭窄进行相关分析。结果 199例患者中,肾动脉成形术成功率97.5%。病变动脉管腔直径狭窄率由(73±11)%降至(12±10)%。术后随访138例患者血压下降明显,收缩压由(161±26)mm Hg(1mm Hg=0.133 kPa)降至(1 37±16)mm Hg,舒张压由(85±1 5)mm Hg降至(77±11)mm Hg,差异有统计学意义(P<0.01);口服降压药物品种明显减少,由平均(2.4±1.2)种降至(1.8±0.9)种(P<0.01);患者手术前后肌酐水平无显著差异,但对术前有肾功能不全患者估测的肾小球滤过率改善差异有统计学意义;术后24个月发生支架内再狭窄14例,非开口病变是再狭窄的危险因素。结论老年高血压肾动脉狭窄患者经皮肾动脉成形术的手术成功率高,并有助于此类患者血压的长期控制,特别是部分肾功能不全患者肾小球率过滤可能会有改善,支架内再狭窄与病变部位相关。
Objective To evaluate the long-term effects of percutaneous transluminal angioplasty (MPA) revascularization on blood pressure and renal function in elderly patients with stenosis of renal artery stenosis and related factors of in-stent restenosis. Methods Ninety-nine patients with renal artery stenosis complicated by hypertension were selected. Renal arterial blood flow was reconstructed by renal angioplasty. After a mean follow-up of (19 ± 11) months, the changes of blood pressure, antihypertensive drugs and renal function were observed, and the correlation between the in-stent restenosis was analyzed. Results Among the 199 patients, the success rate of renal angioplasty was 97.5%. The stenosis rate of arterial lumen decreased from (73 ± 11)% to (12 ± 10)%. The postoperative follow-up of 138 patients decreased significantly (P <0.05). The systolic blood pressure decreased from (161 ± 26) mm Hg (1mm Hg = 0.133 kPa) to (1 37 ± 16) mm Hg and diastolic pressure decreased from (85 ± 1) (77 ± 11) mm Hg, the difference was statistically significant (P <0.01); the number of oral antihypertensive drugs significantly decreased from 2.4 ± 1.2 to 1.8 ± 0.9 (P <0.01); There was no significant difference in creatinine before and after surgery, but there was significant difference in the improvement of glomerular filtration rate estimated before operation in patients with renal insufficiency. Stent restenosis occurred in 14 patients 24 months after operation, Is a risk factor for restenosis. Conclusion The success rate of percutaneous nephrectomy in elderly patients with hypertensive renal artery stenosis is high, and it is helpful to the long-term control of blood pressure in these patients. In particular, glomerular filtration rate may be improved in some patients with renal insufficiency. Internal restenosis and lesion related.