协和医学杂志

2020, v.11(01) 6-11

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去肾交感神经术治疗难治性高血压
Renal Sympathetic Denervation in the Treatment of Resistant Hypertension

李清霖;张宇清;
LI Qing-lin;ZHANG Yu-qing;Department of Cardiology,Fuwai Hospital,Chinese Acdemy of Medical Sciences &Peking Union Medical College;

摘要(Abstract):

难治性高血压(resistant hypertension,RH)是指在改善生活方式基础上应用可耐受的足够剂量且合理的3种降压药物(包括一种噻嗪类利尿剂)治疗至少4周后,诊室和诊室外(包括家庭血压或动态血压监测)血压值仍在目标水平之上,或至少需要4种降压药物才能使血压达标,目前尚缺乏有效的治疗方案。去肾交感神经术(renal sympathetic denervation,RDN)作为RH的一种治疗手段,在病理生理机制上已被基础实验证实。早期Ⅰ代RDN的临床试验结果并不统一,Ⅱ代RDN改进了消融技术并在最近的高血压临床试验应用中得到了阳性结论,同时RDN用于治疗其他疾病的临床试验也产生了阳性结果。但由于目前尚无对肾交感神经活动的具体评估方法,无法准确筛选出适宜行RDN的人群,故其临床应用仍存在争议。
The diagnosis of resistant hypertension is made when a patient's blood pressure( BP) is not under control after taking appropriate lifestyle measures and treatment with optimal or best-tolerated doses of 3 antihypertensive medications( a diuretic should be 1 component) for at least 4 weeks or 4 drugs are required to control BP. The inadequate BP control is confirmed by BP measurements of office and out-of-office( ambulatory BP monitoring and Home BP monitoring). Resistant hypertension lacks effective treatment. As a treatment method of resistant hypertension,the pathophysiology of renal sympathetic denervation( RDN) has been confirmed by basic research. Although early studies using the first-generation came to different conclusions,recent clinical trials have reached a positive result with a radiofrequency ablation system of the secondgeneration. However,the evaluation method for the activity of the renal sympathetic nerve is not clear so that it is hard to accurately screen out the patients who are appropriate for RDN. The clinical application of RDN is still controversial.

关键词(KeyWords): 难治性高血压;去肾交感神经术;介入治疗
resistant hypertension;renal sympathetic denervation;interventional therapy

Abstract:

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作者(Author): 李清霖;张宇清;
LI Qing-lin;ZHANG Yu-qing;Department of Cardiology,Fuwai Hospital,Chinese Acdemy of Medical Sciences &Peking Union Medical College;

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