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目的探讨血流储备分数(FFR)压力导丝监测对指导经皮肾动脉交感神经消融术(RDN)的可行性。方法将11头实验用小型猪分为2组,8头为RDN组,3头为假手术组。消融前先进行左、右肾动脉造影,然后以7F导引导管作为指引,于肾动脉内分别置入射频消融导管和FFR压力导丝,在X线透视下观察导管贴靠肾动脉情况,在肾动脉内不同位置进行电刺激(20Hz),监测FFR数值(肾动脉压力/主动脉压力)。当FFR数值出现显著改变时,即在该靶点处进行消融(50℃,10W,60s)。消融后即刻重复刺激,如果未观察到以上指标的改变,即认为消融有效。结果 RDN组8头实验用小型猪均成功完成肾动脉靶点消融术。消融术前,在靶点处进行电刺激,FFR数值下降,差异有统计学意义(0.98±0.02vs 0.73±0.07,P<0.01);消融术后即刻,在同样的点位进行电刺激,FFR数值几乎没有变化(0.97±0.03vs 0.95±0.02,P=0.25)。在假手术组中未观察到这一现象。结论靶点处电刺激后检测的FFR数值在消融前和消融后即刻差异显著,FFR压力导丝监测有望成为指导RDN的一种新手段,但其有效性及机制尚需进一步验证。
Objective To investigate the feasibility of using FFR pressure guide wire monitoring to guide percutaneous renal artery sympathetic nerve ablation (RDN). Methods 11 experimental miniature pigs were divided into two groups, eight were RDN group and three were sham operation group. Left and right renal artery angiography before ablation, and then guide the catheter 7F as a guide, were placed in the renal artery radiofrequency ablation catheter and FFR pressure guide wire in the X-ray observation of the catheter attached to the renal artery in the case of Electrical stimulation (20 Hz) was performed at different positions in the renal artery and FFR values (renal artery pressure / aortic pressure) were monitored. Ablation (50 ° C, 10 W, 60 s) was performed at this target when there was a significant change in the FFR value. Immediately after ablation stimulation, if no change in the above indicators were observed, that is effective ablation. Results Eight experimental piglets in RDN group were successfully treated with renal artery ablation. Before ablation, electrical stimulation was performed at the target site with a decrease in FFR value (0.98 ± 0.02 vs 0.73 ± 0.07, P <0.01). Immediately after ablation, electrical stimulation was performed at the same site with FFR There was almost no change in the values (0.97 ± 0.03 vs 0.95 ± 0.02, P = 0.25). This phenomenon was not observed in the sham-operated group. Conclusions The FFR values measured at the target site after electrical stimulation are significantly different before and immediately after ablation. FFR pressure guidewire monitoring is expected to be a new method to guide RDN. However, its validity and mechanism need to be further verified.