本文關(guān)鍵詞：優(yōu)化去腎交感神經(jīng)射頻消融術(shù)對頑固性高血壓的療效　出處：《四川醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 腎交感神經(jīng) 去神經(jīng)射頻消融術(shù) 自發(fā)性高血壓大鼠 腎上腺素 去甲腎上腺素

【摘要】：背景:據(jù)2010《中國高血壓防治指南》相關(guān)研究報道,我國高血壓患者已過億,且有逐年遞增的趨勢,約占全球高血壓患者總數(shù)的五分之一,是名副其實的高血壓大國。盡管目前可供選擇的降壓藥物的種類很多,但即便給予了多種不同種類的、足夠劑量的降壓藥物治療后,仍有約10-20%的高血壓患者血壓不能達(dá)標(biāo)。學(xué)術(shù)界將同時服用三種不同種類足量降壓藥(包括一種利尿劑)后血壓仍不能達(dá)標(biāo)者稱為頑固性高血壓患者。這類患者往往合并多重心血管危險因素,長期血壓控制不佳,心腦腎并發(fā)癥接踵而至,臨床預(yù)后差,目前尚無有效可行的解決辦法,是心血管領(lǐng)域臨床治療中非常棘手的難題。此外,高血壓是導(dǎo)致冠心病、心力衰竭和心律失常的源頭疾病,控制好頑固性高血壓有望顯著提高整體心血管疾病的防治水平。交感神經(jīng)的過度激活跟高血壓的發(fā)生密切相關(guān)。近些年來相關(guān)研究表明:腎交感神經(jīng)的過度激活在頑固性高血壓的發(fā)病機制中扮演重要角色。目的:腎交感神經(jīng)的過度激活與高血壓的發(fā)病機制密切相關(guān)。為了有效的控制頑固性高血壓,本實驗旨在探討優(yōu)化腎交感神經(jīng)消融術(shù)對降低頑固性高血壓的療效。方法:按照大鼠體重編號,完全隨機化分組,采用統(tǒng)計軟件產(chǎn)生隨機數(shù)。將30只12周齡雄性自發(fā)性高血壓大鼠(shr)被隨機分為shr手術(shù)組14d(n=10)、shr手術(shù)組28d(n=10)、shr假手術(shù)對照組(n=10);將30只12周齡雄性wistar-kyoto大鼠(wky)被隨機分為wky手術(shù)組14d(n=10)、wky手術(shù)組28d(n=10)、wky假手術(shù)對照組(n=10);以上分組中假手術(shù)對照組于術(shù)前、術(shù)后、術(shù)后14d,術(shù)后28d分別進(jìn)行檢測相關(guān)指標(biāo)(血壓、心率、血液指標(biāo)等),余下的手術(shù)組分別檢測術(shù)前、術(shù)后、復(fù)查時期的血壓、心率和血液指標(biāo)等。所有實驗組均分別采用經(jīng)腹腔雙側(cè)腎動脈外膜去神經(jīng)術(shù),每側(cè)腎動脈由近端致遠(yuǎn)端螺旋分布選4個消融點,每個點非連續(xù)消融30s,分別用2w功率進(jìn)行消融術(shù)。shr手術(shù)組14d(n=10)、wky手術(shù)組14d(n=10),于術(shù)后2周復(fù)查取材;shr手術(shù)組28d(n=10)、shr假手術(shù)對照組(n=10)、wky手術(shù)組28d(n=10)、wky假手術(shù)對照組(n=10)于術(shù)后4周復(fù)查取材。所有大鼠檢測以下指標(biāo):1)、使用大鼠尾智能血壓計測定所有大鼠術(shù)前、術(shù)后、復(fù)查時間段安靜狀態(tài)下收縮壓、舒張壓、心率;2)、采用酶法測定大鼠血漿肌酐、尿素(術(shù)前、術(shù)后、復(fù)查);3)、采用焦酚紅法測定大鼠24h尿蛋白含量,用全自動生化儀檢測尿na+、k+、cl+(術(shù)前、術(shù)后、復(fù)查);4)、采用elisa試劑盒檢測大鼠血漿去甲腎上腺素、腎上腺素和多巴胺含量(術(shù)前、復(fù)查);5)、采用大鼠腎動脈石蠟切片he染色比較shr大鼠和wky大鼠去神經(jīng)術(shù)后腎交感神經(jīng)損傷形態(tài)變化;6)、采用大鼠腎動脈石蠟切片行免疫組化染色比較shr大鼠和wky大鼠去神經(jīng)術(shù)后腎交感神經(jīng)陽性面積表達(dá)百分比;7)、采用大鼠腎動脈石蠟切片行movat五色套染比較shr大鼠和wky大鼠去神經(jīng)術(shù)后腎動脈肌層組織內(nèi)損傷情況;8)、采用he染色法顯示shr大鼠和wky大鼠去神經(jīng)術(shù)后腎臟病理學(xué)形態(tài)變化;9)、采用masson染色法顯示shr大鼠和wky大鼠去神經(jīng)術(shù)后其心肌有無纖維化改變。結(jié)果:1、shr大鼠手術(shù)組和wky大鼠手術(shù)組復(fù)查血壓(收縮壓、舒張壓)較術(shù)前對比均有明顯降低,對其心率無明顯影響。2、shr大鼠和wky大鼠經(jīng)去腎交感神經(jīng)射頻消融術(shù)后,對大鼠腎功能無明顯影響。3、shr大鼠和wky大鼠經(jīng)去腎交感神經(jīng)射頻消融術(shù)后,對大鼠尿電解質(zhì)和24h尿蛋白無明顯影響。4、shr大鼠手術(shù)組和wky大鼠手術(shù)組復(fù)查,血液去甲腎上腺素、腎上腺素和多巴胺含量均較術(shù)前明顯降低。5、去腎交感神經(jīng)射頻消融術(shù)對shr和wky腎交感神經(jīng)形態(tài)損傷6、去腎交感神經(jīng)射頻消融術(shù)能顯著降低shr和wky腎交感神經(jīng)7、去腎交感神經(jīng)射頻消融術(shù)對shr大鼠和wky大鼠腎動脈肌層組織損傷甚微。8、去腎交感神經(jīng)射頻消融術(shù)對SHR大鼠和WKY大鼠腎臟腎小球形態(tài)影響不明顯。9、去腎交感神經(jīng)射頻消融術(shù)可稍緩解SHR大鼠心肌纖維化,對WKY大鼠心肌無明顯影響。結(jié)論:1.采用功率2W,非連續(xù)性消融,成功構(gòu)建經(jīng)腹腔腎動脈去神經(jīng)射頻消融術(shù)降壓模型;2.去神經(jīng)降壓的機制是通過破壞腎交感神經(jīng)活性,降低交感神經(jīng)遞質(zhì)的釋放,從而降低大鼠血壓;3.腎交感神經(jīng)在高血壓的發(fā)病中起到重要作用。
[Abstract]:Background: according to 2010< Chinese Hypertension Prevention Guide > related research reports, China has billions of dollars in hypertensive patients, and there is a rising trend, accounting for about 1/5 of the total global hypertension patients, is worthy of the name of a big country with hypertension. Though many kinds of antihypertensive drugs currently available, but even to a variety of different types of hypertension adequate drug treatment dose, there are still about 10-20% of blood pressure in patients with hypertension. The academic circles can not reach the standards will also take three different kinds of adequate antihypertensive drugs (including a diuretic) after blood pressure still can not be called refractory hypertension patients. These patients often associated with multiple cardiovascular risk factors, long-term poor control of blood pressure, cardiovascular and renal complications ensue, the prognosis is poor, there is no effective and feasible solution, is a very difficult problem in the clinical treatment of the cardiovascular system. That is the source of disease of hypertension cause coronary heart disease, heart failure and arrhythmias, good control of resistant hypertension is expected to significantly improve the overall level of prevention and treatment of cardiovascular diseases. The excessive activation of sympathetic nerve is closely related with the occurrence of hypertension. The related research shows that in recent years, the excessive activation of renal sympathetic nerves play an important role in the pathogenesis of intractable hypertension. Objective: renal sympathetic nerve activation is closely related to the pathogenesis of hypertension. In order to control hypertension effectively, this study aims to investigate the optimization of renal sympathetic nerve ablation on the clinical curative effect of refractory hypertension. Methods: according to the number of rats, completely randomized grouping, generating random numbers using statistical software. 30 only 12 week old male spontaneously hypertensive rats (SHR) were randomly divided into SHR group (14d n=10), SHR operation group, 28d (n=10) SHR hand 鏈鐓х粍(n=10);灝，

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