射频消融治疗高血压的临床研究课件

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,经导管射频消融治疗高血压研究进展,附属第二医院,心内科,经导管射频消融治疗高血压研究进展附属第二医院 心内科,1,我国患病率最高的慢性疾病,总死亡的第一位危险因素,高度致残率,高血压的危害,三高：,患病率高；,死亡率高；,致残率高,三低：,知晓率低；,治疗率低；,控制率低,我国患病率最高的慢性疾病高血压的危害三高：患病率高；死亡率高,2,肾交感神经活动在高血压中的作用？,肾交感神经活动在高血压中的作用？,3,肾交感神经活动,R,enal,S,ympathetic,N,erve,A,ctivity,，,RSNA,肾小管水钠重吸收,肾素释放,肾血管阻力,肾交感传入神经将肾脏感受器的反射信号传导至中枢,再由肾交感传出神经调节血压变化,肾交感神经活动Renal Sympathetic Nerve,4,肾交感神经活动,肾交感神经活动,5,肾交感神经活动,内脏神经切除术：只切除内脏附近的交感神经,交感神经切除术：切除胸腔和腰部全部交感神经、内脏交感神经及腹腔神经节,对控制恶性高血压是有效,围手术期死亡率很高，常伴有体位性低血压，晕厥，肠道、膀胱功能异常，阳痿甚至行走困难等并发症,肾交感神经活动内脏神经切除术：只切除内脏附近的交感神经,6,肾交感神经活动,人类肾交感神经由胸,10,至腰,1,脊髓发出,经腹神经丛沿肾动脉到达肾脏,末梢分布在肾动脉血管外膜并释放去甲肾上腺素,肾交感神经活动人类肾交感神经由胸10至腰1脊髓发出,7,犬肾动脉射频消融后神经密度的改变,肾动脉外膜上粗大的神经干,肾动脉外膜上分布的神经纤维,犬肾动脉射频消融后神经密度的改变肾动脉外膜上粗大的神经干肾动,8,肾交感神经活动,经导管肾交感神经射频消融术？,(catheter-based renal sympathetic denervation,，,CRSD,）,肾交感神经活动经导管肾交感神经射频消融术？,9,已发表的关于经导管肾交感神经射频消融治疗高血压的临床询证医学证据,已发表的关于经导管肾交感神经射频消融治疗高血压的临床询证医学,10,first-in-man study,（,case,）,Schlaich MP, et al. N Engl J Med, 2009; 361: 93234.,first-in-man study（case）Schlai,11,first-in-man study,（,case,）,59-year-old male patient,essential hypertension,resistant to pharmacologic treatment,seven different antihypertensive drugs,renal sympathetic-nerve ablation,Schlaich MP, et al. N Engl J Med, 2009; 361: 93234.,first-in-man study（case）59-yea,12,first-in-man study,（,case,）,Schlaich MP, et al. N Engl J Med, 2009; 361: 93234.,first-in-man study（case）Schlai,13,safety and proof-of-principle cohort study,Krum H, et al. Lancet, 2009; 373:127581.,safety and proof-of-principle,14,safety and proof-of-principle cohort study,Krum H, et al. Lancet, 2009; 373:127581.,50 patients enrolled,Treatment eligibility determined by angiographic evaluation of renal artery anatomy,5 patients not treated,45 patients treated,41 with follow-up available at 1 month,2 lost to follow-up,39 with follow-up available at 3 months,26 with follow-up available at 6 months,20 with follow-up available at 9 months,9 with follow-up available at 12 months,5 with follow-up available at 1 month,5 with follow-up available at 3 months,5 with follow-up available at 6 months,2 with follow-up available at 9 months,safety and proof-of-principle,15,Key Inclusion Criteria,Office SBP 160 mmHg despite 3+ anti-hypertensive medications (including diuretic), or confirmed intolerance to medications,eGFR (MDRD formula) of 45 mL/min/1.73m,2,Primary Endpoints,Peri-procedural and long-term safety,Office blood pressure levels,Krum H, et al. Lancet, 2009; 373:127581.,safety and proof-of-principle cohort study,Key Inclusion CriteriaKrum H,16,safety and proof-of-principle cohort study,safety and proof-of-principle,17,safety and proof-of-principle cohort study,safety and proof-of-principle,18,Released Energy maximum 8 Watt,Temperature between 40-75 ,The generator automatically switch of if temperature is higher than 75 ,Energy application up to 5x for each renal artery, depends on length of the renal artery,Amount of time 2 minutes per 1 energy application,Krum H, et al. Lancet, 2009; 373:127581.,safety and proof-of-principle cohort study,Released Energy maximum 8 Watt,19,safety and proof-of-principle cohort study,safety and proof-of-principle,20,safety and proof-of-principle cohort study,safety and proof-of-principle,21,safety and proof-of-principle cohort study,safety and proof-of-principle,22,safety and proof-of-principle cohort study,Acute Post-,Treatment,Baseline,5 Week,Follow-Up,safety and proof-of-principle,23,safety and proof-of-principle cohort study,Acute Post-,Treatment,Baseline,5 Week,Follow-Up,safety and proof-of-principle,24,safety and proof-of-principle cohort study,30-Day,60-Day,180-Day,safety and proof-of-principle,25,Procedure time: median 38 (IQR 34-48) minutes,Treatment delivered without complication in 43/45,1 renal artery dissection during catheter delivery (before RF energy application),1 femoral pseudoaneurysm, manually reduced without further sequelae,No long-term vascular complications observed,18 patients had angiograms at 14-30 days post-,6-months post-: 14 had MRA, 17 had CTA,Krum H, et al. Lancet, 2009; 373:127581.,safety and proof-of-principle cohort study,Procedure time: median 38 (IQR,26,safety and proof-of-principle cohort study,Krum H, et al. Lancet, 2009; 373:127581.,Office BP,safety and proof-of-principle,27,safety and proof-of-principle cohort study,Krum H, et al. Lancet, 2009; 373:127581.,Renal Function,Norepinephrine Data,safety and proof-of-principle,28,The Symplicity,HTN-1,Trial,Two-Year Durability of BP Reduction with Catheter-based Renal Sympathetic Denervation,Expanded cohort of patients (n=153),24-month follow-up,The Symplicity HTN-1 TrialTwo-,29,The Symplicity,HTN-1,Trial,The Symplicity HTN-1 Trial,30,The Symplicity,HTN-2,Trial,Symplicity HTN-2 Investigators. Lancet, 2010; 376:1903-9.,The Symplicity HTN-2 TrialSymp,31,The Symplicity,HTN-2,Trial,International, multi-center, prospective, randomized, controlled study,190 patients enrolled in 24 centers in Europe, Australia, & New Zealand,6-month follow-up,Symplicity HTN-2 Investigators. Lancet, 2010; 376:1903-9.,The Symplicity HTN-2 TrialInte,32,Key Inclusion Criteria,bilateral single main renal artery of 20 mm length & 4 mm diameter,Primary Endpoint,Automated office systolic BP change,Secondary Endpoints,Acute & chronic procedural safety, cardiovascular events through 6M, other measures of BP reduction at 6M,Symplicity HTN-2 Investigators. Lancet, 2010; 376:1903-9.,The Symplicity,HTN-2,Trial,Key Inclusion CriteriaSymplici,33,Symplicity HTN-2 Investigators. Lancet, 2010; 376:1903-9.,The Symplicity,HTN-2,Trial,Symplicity HTN-2 Investigators,34,Symplicity HTN-2 Investigators. Lancet, 2010; 376:1903-9.,The Symplicity,HTN-2,Trial,6-Month Office BP,Symplicity HTN-2 Investigators,35,Symplicity HTN-2 Investigators. Lancet, 2010; 376:1903-9.,The Symplicity,HTN-2,Trial,Symplicity HTN-2 Investigators,36,Minor adverse events,1 femoral artery pseudoaneurysm treated with manual compression,1 post-procedural drop in BP resulting in a reduction in medication,1 urinary tract infection,1 prolonged hospitalization for evaluation of paraesthesias,1 back pain treated with pain medications & resolved after one month,Symplicity HTN-2 Investigators. Lancet, 2010; 376:1903-9.,The Symplicity,HTN-2,Trial,Minor adverse eventsSymplicity,37,Symplicity HTN-2 Investigators. Lancet, 2010; 376:1903-9.,The Symplicity,HTN-2,Trial,Symplicity HTN-2 Investigators,38,写在最后,成功的基础在于好的学习习惯,The foundation of success lies in good habits,39,写在最后成功的基础在于好的学习习惯39,谢谢大家,荣幸这一路，与你同行,ItS An Honor To Walk With You All The Way,讲师：,XXXXXX,XX,年,XX,月,XX,日,谢谢大家讲师：XXXXXX,40,