患者,女,57岁。主因“间断发作性头晕、头痛9年,加重1周”入院。患者9年前因血压升高开始出现头晕、头胀痛,血压最高达210/130 mmHg。近1周头晕、头痛反复发作,伴有恶心、呕吐,每次发作时测血压均明显升高(190～210/100～130 mmHg)。平时自服“拜新同、替米沙坦、倍他乐克、氢氯噻嗪”降血压治疗,血压控制不理想。患冠心病10余年,2004年行冠脉造影检查及支架植入治疗(具体不详),无不良嗜好,无肝炎、结核等传染病史,无糖尿病史,无外伤及手术史,无家族遗传性疾病史。查体:血压190/80 mmHg,心率80次/min。双肺呼吸音清,未闻及干湿性啰音;心界无扩大,心律齐,心音可,未闻及病理性杂音;腹软,无压痛及反跳痛,双下肢无水肿。临床检查:心电图示窦性心律,非特异性ST-T改变。入院急查生化:K 2.98 mmol/L,Na 135.4 mmol/L,Cl 94.2 mmol/L,Cr 82 μmol/L。择日查血管紧张素Ⅰ、Ⅱ,醛固酮,促肾上腺皮质激素(ACTH),皮质醇(Cor),生长激素(GH)均未见异常。心脏超声(入院):各房室腔内径测值正常,前壁运动不协调,心脏结构、血流未见明显异常。腹部超声示:肝、胆、胰、脾未见明显异常,右肾体积减小,左肾大小正常,双侧肾动脉血流速度增快(右肾:230 m/s,左肾:210 m/s)。结合病史、症状、体征及相关检查考虑诊断为:(1)高血压病3级(极高危);(2)冠状动脉粥样硬化性心脏病,不稳定性心绞痛、冠脉支架置入术后,心功能Ⅰ级(NYHA分级);(3)低钾血症。
关键词
高血压 /
肾动脉狭窄 /
介入治疗
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Safian R D and Textor S C. Renal-artery stenosis [J]. N Engl J Med,2001,344(6):431-442.
[2] Voiculescu A, Grabensee B, Jung G, et al. Renovascular disease: a review of diagnostic and therapeutic procedures [J]. Minerva Urol Nefrol,2006,58(3):127-149.
[3] Harding M B, Smith L R, Himmelstein S I, et al. Renal artery stenosis: prevalence and associated risk factors in patients undergoing routine cardiac catheterization [J]. J Am Soc Nephrol,1992,2(11):1608-1616.
[4] Missouris C G, Buckenham T, Cappuccio F P, et al. Renal artery stenosis: a common and important problem in patients with peripheral vascular disease [J]. Am J Med,1994,96(1):10-14.
[5] Ives N, Gray R.The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure [J]. Arch Intern Med,1997,157(21):2413-2446.
[6] Tendera M, Aboyans V, Bartelink M L, et al. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the task force on the diagnosis and treatment of peripheral artery diseases of the european society of cardiology (ESC) [J]. Eur Heart J,2011,32(22):2851-2906.
[7] Kalra P A, Chrysochou C, Green D, et al. The benefit of renal artery stenting in patients with atheromatous renovascular disease and advanced chronic kidney disease [J]. Catheter Cardiovasc Interv,2010,75(1):1-10.
[8] Cooper C J, Haller S T, Colyer W, et al. Embolic protection and platelet inhibition during renal artery stenting [J]. Circulation,2008,117(21):2752-2760.
[9] Krishnamurthi V, Novick A C,Myles J L. Atheroembolic renal disease: effect on morbidity and survival after revascularization for atherosclerotic renal artery stenosis [J]. J Urol,1999,161(4):1093-1096.
[10] Radermacher J, Weinkove R,Haller H. Techniques for predicting a favourable response to renal angioplasty in patients with renovascular disease [J]. Curr Opin Nephrol Hypertens,2001,10(6):799-805.
[11] Bax L, Woittiez A J, Kouwenberg H J, et al. Stent placement in patients with atherosclerotic renal artery stenosis and impaired renal function: a randomized trial [J]. Ann Intern Med,2009,150(12):840-848.
[12] Wheatley K, Ives N, Gray R, et al. Revascularization versus medical therapy for renal-artery stenosis [J]. N Engl J Med,2009,361(20):1953-1962.
[13] Zeller T, Macharzina R, Rastan A, et al. Renal artery stenosis: Up-date on diagnosis and treatment [J]. Vasa,2014,43(1):27-38.
PDF(690 KB)
