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目的:分析顽固性高血压患者基线因素对肾动脉去交感神经术(RDN)降压疗效的影响,为RDN临床病患的入选提供初步指导。方法:回顾性分析2013-2015年于普陀医院心内科行RDN治疗的23例顽固性高血压患者记录数据,采用单因素筛选和多因素分析得出RDN降压效果的主要影响因素。结果:术前24h平均收缩压水平是影响RDN降压效果的最重要因素。无论低压组(ABPSYS≤150mmHg)还是高压组(ABPSYS>150mmHg)经过RDN术后半年的24h平均收缩压血压都维持在140mmHg左右。低压组患者,术后6个月平均血压减少(8.3±5.7)/(4.6±3.2)mmHg(P>0.05),RDN有效率(术后6个月收缩压值下降大于或等于10mmHg)为62.5%;高压组降压(28.9±12.1)/(12.4±7.4)mmHg(与术前比较P<0.05),RDN有效率高达93.3%。结论:基线血压显著影响RDN降压效果,且ABPSYS>150mmHg患者RDN术降压效果更明显。根据动态血压基线值选择合适的患者,RDN术可以使患者更能获益。
OBJECTIVE: To analyze the influence of baseline factors on the antihypertensive efficacy of renal artery denervation (RDN) in patients with refractory hypertension, and provide preliminary guidance for the selection of clinical patients with RDN. Methods: The data of 23 patients with refractory hypertension treated by RDN in Department of Cardiology, Putuo Hospital from 2013 to 2015 were retrospectively analyzed. The main influencing factors of RDN antihypertensive effect were obtained by single factor screening and multivariate analysis. Results: The mean systolic blood pressure before 24h was the most important factor affecting the antihypertensive effect of RDN. The mean systolic blood pressure at half a year after RDN was maintained at about 140 mmHg regardless of the low pressure group (ABPSYS ≤ 150 mmHg) or the high pressure group (ABPSYS> 150 mmHg). In the low-pressure group, the average blood pressure decreased (8.3 ± 5.7) / (4.6 ± 3.2) mmHg at 6 months after operation (P> 0.05), and the effective rate of RDN decreased by more than or equal to 10 mmHg at 6 months %. The blood pressure of high pressure group was (28.9 ± 12.1) / (12.4 ± 7.4) mmHg (P <0.05 compared with that before operation), and the effective rate of RDN was as high as 93.3%. Conclusion: Baseline blood pressure significantly affects the antihypertensive effects of RDN, and the antihypertensive effect of RDN with ABPSYS> 150mmHg is more obvious. According to the dynamic blood pressure baseline select the appropriate patient, RDN surgery can make patients more benefit.