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目的:探讨肾动脉狭窄导致一过性肺水肿的临床特点,分析其与左室舒张功能不全的鉴别要点。方法:回顾分析2002年5月~2004年5月住院的难治性高血压并发夜间阵发性呼吸困难的患者12例,造影显示单侧或双侧肾动脉狭窄超过50%,肾动脉球囊扩张及支架置入后随访6个月观察临床症状、血压、肾功能的变化。结果:单侧及双侧肾动脉狭窄各6例,7例患者伴有肾功能不全,5例肾功能正常但肌酐清除率<80ml/min。5例患者伴有低血钾(<3.5mmol/L),夜间阵发性呼吸困难发作突然,利尿剂治疗效果好。肾动脉支架置入后3个月血压较治疗前明显降低(P<0·05),7例肾功能不全患者血肌酐降低[(121·5±28·4)μmol/L∶(166.4±46.3)μmol/L(P<0·05)],血钾恢复正常,所有患者夜间阵发性呼吸困难消失。结论:难治性高血压突发夜间阵发性呼吸困难,同时并发肾功能不全、低血钾、利尿剂治疗效果佳,应高度提示肾动脉狭窄导致的肺水肿,而非单纯左室舒张功能不全。
Objective: To investigate the clinical features of renal artery stenosis leading to transient pulmonary edema and to analyze the main points of differential diagnosis of left ventricular diastolic dysfunction. Methods: Twelve patients with refractory hypertension and nocturnal paroxysmal dyspnea admitted to hospital from May 2002 to May 2004 were retrospectively analyzed. Angiography showed that more than 50% of unilateral or bilateral renal artery stenosis, renal artery balloon After 6 months of follow-up, the clinical symptoms, blood pressure and renal function were observed after dilation and stent placement. Results: There were 6 cases of unilateral and bilateral renal artery stenosis, 7 cases were associated with renal insufficiency, 5 cases with normal renal function but creatinine clearance <80ml / min. 5 patients with hypokalemia (<3.5mmol / L), nocturnal paroxysmal dyspnea attack suddenly, diuretic treatment is good. Blood pressure was significantly lower 3 months after renal stent implantation than before treatment (P <0.05), and serum creatinine was decreased in 7 patients with renal insufficiency [(121.5 ± 28.4) μmol / L: (166.4 ± 46.3 ) μmol / L (P <0.05), serum potassium returned to normal, all patients with paroxysmal nocturnal dyspnea disappeared. Conclusions: Sudden onset of paroxysmal nocturnal dyspnea in patients with refractory hypertension, combined with renal insufficiency, hypokalemia and diuretic treatment should be highly suggestive of pulmonary edema caused by renal artery stenosis rather than simple left ventricular diastolic function Incomplete.