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目的观察肾静脉、外周静脉、外周动脉血相关生化指标(肾素、醛固酮、去甲肾上腺素、肾上腺素)在经皮肾动脉交感神经消融术(RDN)后即刻的变化。方法 10头广西巴马小香猪。使用6FJR导引导管行左右肾动脉造影。以7F导引导管作为指引,置入5F温控射频消融导管,在左右肾动脉行RDN。消融模式:温控、50℃、8～10W,采用螺旋式消融,每个点消融60～90s,左、右肾动脉各消融4～6个点,相邻消融点间隔0.5cm。所有动物于术前和消融术后即刻行外周动脉、肾静脉、外周静脉取血,采集并检测去甲肾上腺素、肾上腺素、肾素、醛固酮水平。结果 RDN术后即刻的肾静脉血清肾素、醛固酮、肾上腺素水平分别为(389.6±208.7)、(337.1±156.8)和(313.4±113.2)ng/L,均显著低于术前水平[分别为(453.3±240.8)、(427.7±218.4)和(494.1±144.7)ng/L,P值分别<0.05、0.01],降幅分别为(14.3±0.6)%、(22.4±1.7)%和(22.5±0.9)%。RDN术后即刻和术前的血清去甲肾上腺素水平分别为292.5(625,49)、297.5(871,146)ng/L,差异无统计学意义(P>0.05),降幅为(1.7±0.2)%。肾静脉血的肾素、醛固酮、肾上腺素水平降幅均显著大于外周动脉和外周静脉血(P值均<0.05),外周动脉血与外周静脉血间上述指标的差异均无统计学意义(P值均>0.05)。结论与外周动脉、外周静脉相比较,肾静脉血相关生化指标在消融术后即刻出现显著下降,敏感性较高。
Objective To observe the changes of renal vein, peripheral vein and peripheral arterial blood biochemical markers (renin, aldosterone, norepinephrine and epinephrine) immediately after percutaneous renal artery sympathetic nerve ablation (RDN). Method 10 Bama Xiaoxiang pigs in Guangxi. Left and right renal artery angiography was performed with 6FJR catheter. 7F guide catheter as a guide, into the 5F temperature control RF ablation catheter, left and right renal artery RDN. Ablation mode: temperature control, 50 ℃, 8 ~ 10W, using spiral ablation, each point of ablation 60 ~ 90s, left and right renal artery ablation 4 ~ 6 points, adjacent ablation point interval 0.5cm. Peripheral arteries, renal veins and peripheral venous blood were collected from all animals immediately before and after ablation, and norepinephrine, epinephrine, renin and aldosterone levels were collected and tested. Results The levels of renin, aldosterone and epinephrine in renal vein immediately after RDN were (389.6 ± 208.7), (337.1 ± 156.8) and (313.4 ± 113.2) ng / L, respectively, which were significantly lower than preoperative levels [ (P <0.05,0.01), respectively (P <0.05, P <0.01) with the decrease of (14.3 ± 0.6)%, (22.4 ± 1.7)% and (22.5 ± 0.9)%. The levels of serum norepinephrine in patients with RDN were 292.5 (625,49) and 297.5 (871,146) ng / L, respectively, with no significant difference (P> 0.05), with a decrease of 1.7 ± 0.2% . The levels of renin, aldosterone and epinephrine in renal vein decreased significantly more than those in peripheral artery and peripheral vein (all P <0.05), and there was no significant difference between the peripheral arterial blood and peripheral venous blood (P value All> 0.05). Conclusion Compared with peripheral artery and peripheral vein, the biochemical indexes of renal venous blood drop significantly immediately after ablation and have higher sensitivity.