惡性高血壓另一治療

What is Renal Denervation?

Majority of patients with Hypertension and no identifiable secondary causes have demonstrated activated sympathetic nervous system and increased sympathetic outflow.¹  

Because of lack of therapeutic options sympathectomy for the treatment of malignant hypertension (terminology then abandoned) appears to have taken place for the first time in Germany as early as 1923(9). 

During late 1930′s first report of non-selective thoracolumbar splanchnincectomy (from the 8^th to the 12^th dorsal root ganglion) from the United Stated was published to treat hypertension. 

Clinical trial data demonstrated 5-year mortality rates of those treated surgically, n=1266, of 19%.¹  

In comparison patients that did not undergo the surgery, n=467, the 5-year mortality rate was 54%. Some successfully operated patients had lower BP that extended up to 10 years. By 1960s there were multiple reports proving the effectiveness of sympathectomy in treatment of malignant HTN. 

At the same time every report suggested that the operating technique required prolonged hospitalization and long recovery period. 

The procedure had very serious procedural risks and some adverse events included orthostatic hypotension, orthostatic tachycardia, palpitations, breathlessness, anhidrosis, cold hands, intestinal disturbances, loss of ejaculation, sexual dysfunction, thoracic duct injuries, and atelectasis.¹

Multiple reports in 1950s evaluated effect of ganglion-blocking agent in the treatment of malignant hypertension. 

Harrington et al. reported improved life expectancy with the treatment of ganglion blocking treatment.²

^摘自:

^{http://www.renaldenervationworld.org/professional-education/what-is-rdn/}