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经皮肾交感神经射频消融术对重度心力衰竭患者的影响。

Effect of percutaneous renal sympathetic nerve radiofrequency ablation in patients with severe heart failure.

作者信息

Dai Qiming, Lu Jing, Wang Benwen, Ma Genshan

机构信息

Department of Cardiology, Zhongda Hospital, Southeast University Nanjing 210009, Jiangsu, China.

出版信息

Int J Clin Exp Med. 2015 Jun 15;8(6):9779-85. eCollection 2015.

Abstract

This study aimed to investigate the clinical feasibility and effects of percutaneous renal sympathetic nerve radiofrequency ablation in patients with heart failure. A total of 20 patients with heart failure were enrolled, aged from 47 to 75 years (63±10 years). They were divided into the standard therapy (n = 10), and renal nerve radiofrequency ablation groups (n = 10). There were 15 males and 5 female patients, including 8 ischemic cardiomyopathy, 8 dilated cardiomyopathy, and 8 hypertensive cardiopathy. All of the patients met the criteria of New York Heart Association classes III-IV cardiac function. Patients with diabetes and renal failure were excluded. Percutaneous renal sympathetic nerve radiofrequency ablation was performed on the renal artery wall under X-ray guidance. Serum electrolytes, neurohormones, and 24 h urine volume were recorded 24 h before and after the operation. Echocardiograms were performed to obtain left ventricular ejection fraction at baseline and 6 months. Heart rate, blood pressure, symptoms of dyspnea and edema were also monitored. After renal nerve ablation, 24 h urine volume was increased, while neurohormone levels were decreased compared with those of pre-operation and standard therapy. No obvious change in heart rate or blood pressure was recorded. Symptoms of heart failure were improved in patients after the operation. No complications were recorded in the study. Percutaneous renal sympathetic nerve radiofrequency ablation may be a feasible, safe, and effective treatment for the patients with severe congestive heart failure.

摘要

本研究旨在探讨经皮肾交感神经射频消融术在心力衰竭患者中的临床可行性及效果。共纳入20例心力衰竭患者,年龄47至75岁(63±10岁)。他们被分为标准治疗组(n = 10)和肾神经射频消融组(n = 10)。其中男性15例,女性5例,包括缺血性心肌病8例、扩张型心肌病8例、高血压性心脏病8例。所有患者均符合纽约心脏协会心功能Ⅲ - Ⅳ级标准。排除糖尿病和肾衰竭患者。在X线引导下对肾动脉壁进行经皮肾交感神经射频消融术。记录手术前后24小时的血清电解质、神经激素及24小时尿量。在基线及术后6个月行超声心动图检查以获取左心室射血分数。同时监测心率、血压、呼吸困难及水肿症状。肾神经消融术后,24小时尿量增加,与术前及标准治疗相比,神经激素水平降低。心率及血压无明显变化。术后患者心力衰竭症状改善。本研究未记录到并发症。经皮肾交感神经射频消融术对于重度充血性心力衰竭患者可能是一种可行、安全且有效的治疗方法。

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