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[TCT2012]肾脏去神经术的最新进展——Michael Bohm教授专访

作者:国际循环网   日期:2012/10/26 17:15:41

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我们在450例患者中确定了对RND有反应的临床预测因子。最佳也是唯一的预测因子是基线时血压水平。血压越高,反应越强。年龄、肾功能、肥胖、糖尿病与之均无交互作用,这与我们原来的设想不同,这些都不是真正的预测因子。心率是另一个因素,心率快的患者在血压之外有更好的应答。患者根据血压和心率水平对RND应答。

  International Circulation: Do you think we’re ever going to start seeing some harmful side effects from the procedure such as stenosis? Are there adaptive features that we do need?
  Prof. Bohm: There are also studies addressing these. There is no evidence that we develop chronotropic incompetence or reduce exercise tolerance because the sympathetic nervous system is reduced. This has been vigorously studied in a paper and came out in JACC there is no sign of orthostatic dysreguatlion, which was another concern and which was a big problem in these operations done in the 50s. This is not the case. There is no worsening of renal function, in fact, there is improvement in renal function due to unloading of the kidney. Renal artery stenosis can occur: we have seen 2 patients out of 450. However, this renal artery stenosis occurred nine-months after the procedure. The question is whether this happened by chance or is a natural response of atherosclerotic disease of the kidneys to develop stenosis. There is so far no evidence that stenosis is significantly and causally related to procedure.
  《国际循环》:您认为我们会开始见到RND的不良反应,例如再狭窄?我们需要适应性的
  Bohm教授:有一项研究正在探讨这个问题。没有证据表明,由于交感神经切除,导致变时性机能不全无力或运动耐力的降低。JACC的一篇文章非常严格地进行了研究,没有直立性血压调节的问题,这个问题在50年代手术切除交感神经时很严重。肾功能没有恶化,实际上由于肾脏负荷的减少,肾功能还有所改进。肾动脉狭窄可能发生,在我们的450例患者中,有2例出现这样的问题。然而,肾动脉狭窄发生于术后9个月,这是偶然发生的还是动脉粥样硬化的自然病程的体现,仍然不清楚。到目前为止,没有证据表明肾动脉狭窄是RND引起的,是有显著意义的。

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