腎交感神經射頻消融術治療頑固性高血壓的研究進展

[摘要] 原發性高血壓是以體循環動脈壓增高為主要表現的臨床綜合征，長期高血壓可影響重要臟器尤其是心、肺、腎的功能，最終導致臟器功能衰竭。頑固性高血壓也稱為難治性高血壓，定義為在改善生活方式的基礎上，應用足夠劑量且合理的3種或以上降壓藥物（包括利尿劑）之后血壓仍未達標。此類患者易發生多種危重并發癥如心腦血管意外（如腦卒中、心力衰竭、心肌梗死等）、腎功能衰竭，甚至猝死。因此，應積極調整不當生活方式、采用合理藥物治療以最大程度降低血壓，若血壓仍控制不佳的高危患者可考慮腎交感神經射頻消融術。

[關鍵詞] 頑固性高血壓；腎交感神經射頻消融術

[中圖分類號] R544.1 [文獻標識碼] A [文章編號] 2095-0616（2012）21-63-03

Study process of treating resistant hypertension by renal sympathetic denervation

SONG Tingting

Shijitongle Community Health Station of Changfeng Lane Baiyu Community Health Center in Shanghai Putuo District， Shanghai 200063，China

[Abstract] Primary hypertension is a syndrome which characterizes as elevated arterial blood pressure of systemic circulation.Long term of high blood pressure may cause drawbacks on important organs such as heart， lung and kidney which may due to function loss at last.Resistant hypertension is defined as blood pressure above the target range set by current guidelines despite the control of lifestyle and three or more antihypertensive drugs of different classes，including a diuretic，at their maximum or highest tolerated doses. Those patients are at a high risk of the occurrence cerebro-vascular events which may threaten their lives. As a result，it is quite critical to control blood pressure in these people，with improving lifestyle and better drug combination，or renal sympathetic denervation.

[Key words] Resistant hypertension；Renal sympathetic denervation

高血壓已成為中西方國家最常見的慢性疾病之一，但各國的控制率、達標率均報道不一。根據我國衛生部《中國心血管病報告2008-2009》數據顯示，我國目前高血壓患者至少2億，每年因高血壓導致的心血管疾病死亡人數可高達100萬人，因此控制血壓在預防心血管疾病的發生與死亡中具有重要作用。2010年中國高血壓防治指南[1-2]指出，在改善生活方式基礎上，應用足夠劑量且合理的3種降壓藥物（包括利尿劑）之后，血壓仍在目標水平（一般人群140/90 mm Hg，糖尿病患者130～139/80～85 mm Hg，慢性腎臟疾病130/80 mm Hg）之上，或至少需要4種藥物才能使血壓達標時，稱為頑固性高血壓（也稱難治性高血壓）[3]。據報道[4]，我國頑固性高血壓的發病率占高血壓患者的10%～20%，而國外報道發生率為16%～22%[5-6]。……