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肾动脉狭窄介入治疗肾功能的保护课件

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动脉 狭窄 介入 治疗 肾功能 保护 课件
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单击此处编辑母版标题样式 单击此处编辑母版副标题样式 *1 • 北京大学 第一医院 肾动脉狭窄介入治疗: 肾功能的保护 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 肾动脉介入治疗 • 肾动脉狭窄的首选治疗 • 技术成功率, ~100% • 长期通畅率, 90% @ 5yrs • 血压的获益率,~80% • 肾功能的改善 ? • 肾功能的恶化, @ 20% With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society • C.M. 1-2 days,1-2wks恢复 • 再狭窄: 3-6 months • 肾动脉硬化病变进展: months • 再灌注损伤: days-wks • 肾动脉远端栓塞 : 3-8 wks. 造成肾功能恶化的病因 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 防治造影剂肾损伤 • 尽可能少用 • CM 选择 • 术前后的水化 • N-乙酰半胱氨酸(N-acetylcystein) • Dialysis RCT:12% to 4% Kay J. et al JAMA 2003;289:553 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 远端栓塞 • 60 RAS, mean 73.3 yrs. • Guding at the ostium drawing blood • 1-3mm plaques in 25 (41,7%)  potential emboli WALKER C ET AL AM. J. CARDIOL 2002; 90 : 28 H With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 远端栓塞:粥样斑块与胆固醇结晶 发生率?不易诊断 没有有效的治疗 有效的预防!! With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 预防措施 • • 病例的选择病例的选择 – – 年龄年龄 – – 基础功能基础功能 – – 严重的主动脉、肾动脉硬化严重的主动脉、肾动脉硬化 • • 技术操作技术操作 – – 尽可能轻柔尽可能轻柔 – – 选择小直径器材(选择小直径器材(low profilelow profile)) • • EPDEPD With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society Remarkable sclerosis With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society EPD • • Filters Filters – – EPI filter wire EPI filter wire – – Angioguard Angioguard – –etc etc • • DistalDistal protection balloon protection balloon With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society M,67yrs. HBP Scr 148 ummol/L filterwire (1) With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society (2) Comparison: bef. and aft. stenting With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society F/ 79 yrs. Scr 260 umml/ L With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society M. 71yrs. Scr 198 umml/L angioguard With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society Angioguard (1) With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society (2) With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society (3) With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 远端保护下 PRI 肾功能肾功能 FU FU : 12,2 ± 4 M (1-65): 12,2 ± 4 M (1-65) • • N=67 N=67,,FU 6 m.FU 6 m. – – 稳定稳定: 53: 53 – – 改善改善: 14: 14 – – 恶化恶化: 0: 0 • • N=29 N=29,,FU 3 yrs.FU 3 yrs. – – 稳定稳定: 21: 21 – – 改善改善: 6: 6 – – 恶化恶化: 2 ( 7%): 2 ( 7%) Henry,Nancy French With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 远端保护下 PRI •46 例开口病变支架 •Angioguard filters •65% 有颗粒物捕获 •FU 12 mo. •肾功能改善和稳定 95 % •5 % 恶化 HOLDEN A.J.VASC.SURG.2003;38:762-768 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 个人病例 • 2003.3-2005.2 106 例肾动脉支架 • 62/106 高危患者 Scr. 138-495 ummol/L • 本组研究 30 例 • EPD=14 例(肾动脉=17) • Non-EPD =16 例(肾动脉=20) • FU 12.7 mo. With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 个人病例 • EPD 组: Scr. 有下降 (mean 6.44umol/L) • 没有恶化病例 • Non-EPD 组: Scr. 升高 (mean 1.1umol/L) • 3例恶化 • 捕获颗粒肉眼见 2 例,显微镜下 7 例 (53%) With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 捕获的颗粒 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 典型病例 • 男性64 岁, HBP 30 yrs • 肾功能异常 10 yrs. Scr 174umol/L • 4 月前 Scr 282.9 umol/L • 10周前 Scr 495umol/L,Ccr17.54ml/min, BUN 25.1mmol/L,GFR L.4ml/min,R.GFR 2ml/min. 开始透析 CRRT With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 远端保护下双侧 PRI • 支架后1 wk • Bp.120~135/65~70mmHg, Scr 300 umol/L • 2 月: GFR L.19ml/min, R.6ml/min • 7 月: Scr332umol/L • 1 yr. FU: Scr300-350 umol/L • 支架后1周摆脱透析3年 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 小结 • PTA/S, 肾动脉狭窄治疗的首选 • 造影剂肾病的预防以水化最为重要 • 远端栓塞可能也是肾功能恶化的原因 • 高风险患者使用EPD可能获益 • 等待大批RCTs结果 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society Thanks
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