治療頑固性高血壓的新突破－射頻燒灼腎交感神經阻斷術

Novel Treatment of Resistant Hypertension-Radiofrequency Ablation of Renal Sympathetic Nerve

陳立威(Li-Wei Chen) ； 王岡陵(Kang-Ling Wang) ； 宋思賢(Shih-Hsien Sung) ； 陳適安(Shih-Ann Chen)

《內科學誌》 22卷6期 (2011/12) Pp. 383-391

https://doi.org/10.6314/JIMT.2011.22(6).01

摘要

本態性高血壓影響人類健康甚鉅，而其致病機轉相當複雜。處理高血壓，目前的建議大多是飲食生活習慣的調整後如果尚未改善到標準，便須考慮使用藥物長期治療。可惜的是不到一半的患者能夠因此把血壓控制穩定，就算在仔細的診療加上各方面多管齊下矯正後，依舊有部分的人血壓偏高，稱之為頑固性高血壓（resistant hypertension）。這類患者因高血壓產生心血管疾病的風險也是最高。由此可知我們仍然需要更有效、更安全甚至更方便的降血壓療法。腎臟交感神經在高血壓的形成上扮演重要角色，過去也曾以手術方式將其切除來改善血壓，雖然有顯著效果但是因為會導致嚴重併發症而無法被廣泛接納。近年研發出以經皮動脈導管方式，利用射頻燒灼（radiofrequency ablation）能量選擇性破壞掉腎臟交感神經的方式。在經過初期試驗證實這種方法安全性無虞後，較長期間的追蹤也觀察到對於頑固性高血壓可以有持續改善的效益。當然目前對於此新興治療方式上存在諸多疑問。本綜論將介紹腎臟交感神經系統在高血壓病生理學的作用，過去歷史中外科去除交感神經所獲得的經驗，現在射頻燒灼腎交感神經阻斷術的試驗結果及探討未來此方式的發展潛力及挑戰。

關鍵字

高血壓 ； 頑固型高血壓 ； 腎交感神經 ； 射頻燒灼術

並列摘要

Essential hypertension is a global cardiovascular disease burden, and its pathophysiology is multifactorial. General recommendations of management include therapeutic life style interventions with combination of various anti-hypertensives if indicated. Unfortunately, less than half of hypertensive patients are able to achieve ideal blood pressure goal, and even if optimal treatment is applied substantial numbers of patients still suffer from uncontrolled blood pressure, a condition known as resistant hypertension, which leaves them at high cardiovascular risk. These problems call for other possible interventions being more effective, safer or even more compliant. Renal sympathetic nerves play crucial role in hypertension development, and surgical sympathectomy has ever been documented with significant blood pressure lowering effect, but it was abandoned due to severe adverse events. Recently, a percutaneous, catheter-based approach using radiofrequency ablation has been innovated to selectively denervate renal sympathetic nerves. Safety has been proved by small scale human studies, and long term follow up has also revealed a sustained blood pressure reduction efficacy. At present, there are still many questions far from being thoroughly answered about this procedure. In this brief review we introduce the physiology of renal sympathetic system in hypertension, look into the past experiences of surgical denervation, collect the data of current renal nerve ablation and discuss its challenges and future potential applications. (J Intern Med Taiwan 2011; 22: 383-391)

並列關鍵字

Hypertension ； Resistant hypertensionl ； Renal sympathetic nerve ； Radiofrequency ablation