| Objective: Percutaneous renal artery sympathetic nerve ablation(RDN)was used to treat refractory hypertension(RH).the patients were followed up for 3 to 18 months after the operation to record the blood pressure,antihypertensive drugs,organ function changes,the occurrence of adverse events related to the operation,as well as ablation impedance,power,time,temperature and other parameters during the operation.through analysis and treatment,the clinical efficacy and safety of the operation were evaluated,and the RDN technique was explored and improved to provide new methods and ideas for the treatment of clinically refractory hypertension.Methods: This study collected 10 RH patients diagnosed by cardiovascular department of the first affiliated hospital of Fujian medical university from September 2016 to may 2018 and received RDN for a follow-up period of 3 to 18 months,of which 6 were followed up > 12 months and 8 were followed up > 3 months.All 10 patients were treated with RDN via renal artery radiofrequency catheter.the preoperative blood pressure,antihypertensive drugs,organ function,intraoperative ablation impedance,power,time,temperature and other parameters,as well as the changes of blood pressure,antihypertensive drugs,related organ function and the occurrence of operation-related side effects in 1 week,1,3,6 and 12 months after operation were recorded.SPSS 23 statistical software was used for data analysis and processing.t test method was used.the difference expressed by p < 0.05 was statistically significant.the clinical efficacy and safety of RDN in RH treatment were evaluated.the operation experience was summarized,the operation method was improved,and the clinical popularization was instructed.Results: By comparing the data of preoperative and postoperative follow-up for 1 week,1,3,6 and 12 months,6 patients with one-year follow-up showed that the family self-test systolic pressure and diastolic pressure decreased significantly compared with those before operation,and the difference was statistically significant(p < 0.05),and the blood pressure gradually stabilized with the extension of follow-up time.83.33 % of them were followed up for more than 3 months and their blood pressure reached the standard(90 mmHg ≤ SBP < 140 mmHg).There was no significant difference between the mean systolic blood pressure and diastolic blood pressure at 1 week and 1 month after operation compared with 3 and 6 months after operation,but the difference was statistically significant(p < 0.05)compared with 12 months after operation,which indicated that the decrease of blood pressure was most significant at 1 month after operation.The follow-up of ambulatory blood pressure monitoring showed that the average systolic blood pressure and diastolic blood pressure in the whole day after operation were significantly lower than those before operation.The number of antihypertensive drugs decreased from 6.17 0.98 before operation to 5.0±1.55,3.67±1.03,3.67±0.52,3.33±0.52 and 3.17±0.75 respectively,the difference was statistically significant(all p < 0.05).After RDN treatment,blood pressure decreased steadily without rebound phenomenon and antihypertensive drugs decreased significantly,which indicated that rdn treatment of refractory hypertension in this group had a significant effect.Compared with 1 week,3 months and 12 months after operation,the renal sympathetic nerve activity indexes such as adrenaline and norepinephrine decreased significantly before operation(p < 0.05),which showed that RDN could reduce renal sympathetic nerve activity to some extent and reduce blood pressure through this mechanism.There was no statistically significant difference in serum creatinine,serum urea nitrogen,cystatin c and glomerular filtration rate between pre-operation and one week,one month,three months,six months after operation(all p > 0.1),which showed that RDN operation had no obvious damage to renal function and was relatively safe.Pain was that most common symptom dure the operation.in 10 cases,9 case had different degrees of pain during the operation,all of them were relieved with analgesic drug,and 1 case had no pain discomfort.Hematoma occurred in 1 case after operation,which was related to the local compression bandage of puncture site.Pseudoaneurysm occurred in 1 case.One patient presented with left renal artery reverse dissection and was implanted with stents.There were no complications such as renal artery stenosis,renal artery dissection,sepsis,puncture site infection,thromboembolism and arteriovenous fistula in other cases.And there was no serious hypotension within 12 months after the operation,so RDN was a safer operation.Through the research and exploration of surgical methods,it is found that:(1)the three-dimensional modeling of renal artery before ablation can accurately fix-point spiral ablation,making the ablation point distribution more uniform and scientific;(2)increasing the ablation of renal artery branches to improve the ablation efficiency of renal sympathetic nerve;increasing ablation power can also improve the efficiency(3)of renal sympathetic nerve.the use of cold saline perfusion pressure ablation catheter(4)can reduce the electrode temperature,fully output energy,realize deeper and larger ablation damage,and can reduce the temperature at the contact point between the electrode and tissue,and reduce the formation of eschar and thrombus.Conclusion: The clinical efficacy of RDN in the treatment of refractory hypertension in this group is remarkable.the blood pressure drops steadily after operation,the number of drugs decreases,the operation-related side effects are few,and it is relatively safe.the improvement of three-dimensional modeling technology,increasing the renal artery branch ablation,adjusting the ablation power,and using cold saline perfusion pressure ablation catheter before operation make it more diversified than the traditional RDN operation.it is worth further research,promotion and application in the treatment of refractory hypertension in clinic. |
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