1 郑州市心血管病医院心血管内科，郑州 450000
目的：研究三维标测系统指导下射频消融去肾交感神经术(renal sympathetic denervation，RSD)对高血压犬模型血压和心脏功能的影响。方法：10只合格的比格犬适应性喂养1周后随机分为手术组和假手术组(n=5)，均造成高血压模型犬，造模后手术组在CARTO三维标测系统指导下实施RSD 术，假手术组仅行双肾动脉造影术。获取比格犬血压监测数据，术前(造模后12周)、术后2周行超声心动图检查，测定心脏功能指标，同时采集血清标本测定血管紧张素II(angiotensin II，AngII)、丙二醛(malondialdehyde，MDA)、一氧化氮(nitric oxide，NO)浓度。结果：两组比格犬造模前、造模后12周收缩压(systolic blood pressure，SBP)、舒张压(diastolic blood pressure，DBP)及平均动脉压(mean arterial pressure，MAP)比较无统计学意义(P>0.05)；与造模后12周比较，手术组术后2，4，8周SBP，DBP及MBP水平显著下降(P<0.05)；与假手术组比较，手术组术后2，4，8周时SBP，DBP及MAP水平显著降低(P<0.05)。术后手术组左室收缩末期内径(left ventricular end-systolic diameter，LVESD)、左室舒张末期内径(left ventricular end-diastolic diameter，LVEDD)、心输出量(cardiac output，CO)、心脏指数(cardiac index，CI)及左室射血分数(left ventr icular ejection fraction，LVEF)显著改善，且LVESD，LVEDD明显低于假手术组，CO，CI，LVEF明显高于假手术组(P<0.05)。术后手术组血清AngII，MDA，NO水平显著改善，且AngII和MDA水平明显低于假手术组，NO水平明显高于假手术组(P<0.05)。结论：三维标测系统指导下RSD可有效降低高血压犬模型血压及改善心脏功能，可能与其抑制肾素血管紧张素系统、减轻氧化应激反应及改善血管内皮功能有关。关键词： 三维标测系统；射频消融去肾交感神经术；高血压犬模型；血压；心脏功能
Effect of three-dimensional mapping-guided radiofrequency ablation of renal sympathetic denervation on blood pressure and cardiac function in hypertensive canine models
CorrespondingAuthor:ZHOU Peng Email: firstname.lastname@example.org
Foundation: This was supported by the Key Project of Henan Medical Science and Technology Tackling, China (201302029).
Objective: To investigate the effect of three-dimensional mapping-guided radiofrequency ablation of renal sympathetic denervation (RSD) on the blood pressure and cardiac function in hypertensive canine models. Methods: Ten qualified beagle dogs were randomly divided into the operation group and the sham operation group with 5 dogs in each group after 10 weeks of adaptive feeding. All of them were used for hypertensive canine models. The operation group was treated by RSD under the guidance of CARTO 3D mapping system after modeling while the sham operation group was given bilateral renal arteriography. The blood pressure monitoring data were obtained. Echocardiography was performed before operation (12 weeks after modeling) and 2 weeks after operation to determine the cardiac function parameters. Serum samples were collected to determine the levels of angiotensin II (AngII), malondialdehyde (MDA) and nitric oxide (NO). Results: There was no statistically significant difference in the systolic blood pressure (SBP), diastolic blood pressure (DBP) or mean arterial pressure (MAP) in the two groups before modeling and at 12 weeks after modeling (P>0.05). The SBP, DBP and MBP in the operation group at 2, 4 and 8 weeks after operation were significantly lower than those at 12 weeks after modeling (P<0.05), and those in the sham operation group (P<0.05). The left ventricular endsystolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), cardiac output (CO), cardiac index (CI) and left ventricular ejection fraction (LVEF) in the operation groups were significantly improved after operation. The LVESD and LVEDD were significantly smaller than those in the sham operation group, while CO, CI and LVEF were significantly larger than those in the sham operation group (P<0.05). The levels of serum AngII, MDA and NO in the operation group were significantly improved after operation, and the levels of AngII and MDA were significantly lower than those in the sham operation group while the level of NO was significantly higher than that in the sham operation group (P<0.05). Conclusion: The three-dimensional mapping system guided RSD can effectively decrease the blood pressure and improve the cardiac function in hypertensive canine models, which may be related to inhibiting the renin-angiotensin system, reducing oxidative stress response and improving endothelial function.Keywords： three-dimensional mapping system; radiofrequency ablation renal sympathetic denervation; hypertensive canine model; blood pressure; cardiac function