摘要目的 探讨血流储备分数(FFR)在主动脉夹层累及肾动脉患者介入治疗中的应用价值.方法 回顾性分析2013年5月至2014年2月在北京安贞医院治疗的12例Stanford B型主动脉夹层导致单侧肾动脉受累缺血患者的临床资料.主动脉造影显示肾动脉受累的患者在进行肾动脉FFR检查后,行胸主动脉腔内修复术.术后再次行肾动脉FFR检查,FFR＞0.90的患者终止手术;FFR≤0.90或肾动脉狭窄近端与远端的平均压压差＞20 mmHg(1 mmHg =0.133 kPa)的患者则进行肾动脉支架置入术.术后1个月检查肾功能;术后1和3个月行超声造影检查.结果 胸主动脉腔内修复术前,1例患者的受累肾动脉FFR值为0.90,其余11例患者的受累肾动脉FFR＜0.90.术后即刻血管造影,示8例患者的两侧肾动脉血流畅通,FFR＞0.90;4例患者的受累肾动脉FFR＜0.90,完成肾动脉支架置入术后FFR＞0.90.术后1个月,血尿素[(8.84±3.99) mmol/L比(5.18±1.69)mmol/L,P=0.011]和尿酸[(359.3±77.3) μmol/L比(276.9±108.3) μmol/L,P=0.008]均较术前降低,血肌酐手术前后差异无统计学意义(P =0.760).术后1和3个月,超声造影示患者肾动脉血流均通畅.结论 对肾动脉受累的Stanford B型主动脉夹层患者进行FFR检查,可数据化评估靶器官的血流灌注,并指导介入治疗.

abstractsObjective To analyze the value of fractional flow reserve (FFR) measurement on endovascular therapy for patients with renal artery stenosis.Methods Clinical data of 12 patients with Stanford B type aortic dissection complicated with renal blood flow injury in Anzhen hospital hospitalized from May 2013 to February 2014 were retrospectively analyzed.Renal artery angiography was performed and fractional flow reserve (FFR) was measured before Thoracic endovascular aortic repair.After operation, renal artery FFR was measured again, and renal artery stenting was performed in patients with FFR≤0.90 or average pressure difference between proximal and distal of renal artery ＞ 20 mmHg(1 mmHg =0.133 kPa) and not applied for patients with FFR ＞ 0.90.The patients were then subsequently followed up clinically.Kidney function were measured after 1 month, and contrast-enhanced ultrasonography data were obtained at 1 and 3 months later, respectively.Results The FFR of 1 patient was 0.90, while the FFR of other patients were less than 0.90 before thoracic endovascular aortic repair.After the procedure, the angiography showed that the blood flow of renal artery in 8 patients were fluency, and the FFR index was over 0.90.There were 4 patients with FFR less than 0.90.After renal artery stenting, the FFR of these 4 patients were all above 0.90.Compared with pre-procedure, blood urea nitrogen ((8.84 ± 3.99) mmol/L vs.(5.18 ± 1.69) mmol/L, P =0.011) and uric acid ((359.3 ± 77.3) μmol/L vs.(276.9 ± 108.3) μmol/L, P =0.008) decreased significantly after 1 month, and there was no significant difference in serum creatinine (P =0.760).Contrast-enhanced ultrasonography results showed that blood flow of renal artery were fluency after 1 month and 3 months.Conclusion In patients with aortic dissection complicating renal blood flow injury, the FFR measurement is meaningful in evaluating the blood flow status of target organs and guide the endovascular revascularization