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目的探讨双肾动脉栓塞术在尿毒症患者长期血液透析后肾素依赖性难治性高血压治疗中的安全性及其疗效。方法回顾性分析12例行双肾动脉栓塞术的尿毒症血液透析后肾素依赖性难治性高血压患者术前及术后临床资料并进行比较。结果 12例患者栓塞成功率100%,术后1例(8.33%)出现较为严重的梗死后综合征,2例(16.67%)出现股动脉穿刺处血肿。1例术后随访3月后出现血压控制不佳,后续行双肾切除术。所有患者术后均按治疗计划行血液透析及口服降压药物治疗。所有患者术后血压明显低于术前。患者术前肾素、血管紧张素Ⅰ和血管紧张素Ⅱ水平高于参考值[术前均值分别为(5.95±0.47)μg/(L·h)、(5.38±0.90)μg/L、(108.2±10.8)ng/L,参考值分别为0.05~0.79μg/(L·h)、(0.50±0.23)μg/L,(85.3±30.0)ng/L],术后1周检测肾素、醛固酮、血管紧张素Ⅰ和血管紧张素Ⅱ水平较术前明显降低[分别为(1.99±0.47)比(5.95±0.47)μg/(L·h),(108.4±10.1)比(138.4±18.6)ng/L,(1.01±0.49)比(5.38±0.90)μg/L,(92.4±9.6)比(108.2±10.8)ng/L,均P<0.05]。肌酐及尿素氮水平术前术后比较,差异无统计学意义(均P>0.05)。结论双肾动脉栓塞术治疗尿毒症患者长期血液透析后肾素依赖性难治性高血压安全、有效。
Objective To investigate the safety and efficacy of dual renal artery embolization in the treatment of renin-dependent refractory hypertension after long-term hemodialysis in uremic patients. Methods Preoperative and postoperative clinical data of 12 patients with renin-dependent refractory hypertension after hemodialysis were retrospectively analyzed and compared in 12 patients undergoing renal artery embolization. Results The successful rate of embolization was 100% in 12 patients. Post-infarction syndrome was found in 1 patient (8.33%) and hematoma in femoral artery puncture in 2 patients (16.67%). One case was followed up for 3 months and had poor blood pressure control. The follow-up nephrectomy was performed. All patients were treated according to the treatment plan hemodialysis and oral antihypertensive drugs. Postoperative blood pressure was significantly lower in all patients than in preoperative. The preoperative levels of renin, angiotensin I and angiotensin II were higher than the reference value (mean preoperative values were (5.95 ± 0.47) μg / (L · h), (5.38 ± 0.90) μg / L, (108.2 ± 10.8 ng / L, the reference values were 0.05 ~ 0.79 μg / (L · h), (0.50 ± 0.23) μg / L and (85.3 ± 30.0) ng / L] (1.99 ± 0.47) vs (5.95 ± 0.47) μg / (L · h), (108.4 ± 10.1) vs (138.4 ± 18.6) ng · (-1) respectively, and the levels of angiotensin Ⅰ and angiotensin Ⅱ were significantly decreased / (1.01 ± 0.49) vs (5.38 ± 0.90) μg / L, (92.4 ± 9.6) vs (108.2 ± 10.8) ng / L, all P <0.05]. Creatinine and urea nitrogen levels before and after surgery, the difference was not statistically significant (P> 0.05). Conclusion Renal embolization in patients with uremia after long-term hemodialysis renin-dependent refractory hypertension safe and effective.