[GWICC2011]高血压病经皮治疗的现状——Prof Steven R. Bailey访谈
正如医生们早已了解的那样,我们发现,如果你压迫颈动脉窦,会通过大脑引起非常重要的反应,即减少了交感神经的信号输出而增加了副交感神经的信号输出。通过这种反应可以降低心率——这就是很多医生通过按摩颈动脉窦治疗心律失常的原因。按摩颈动脉窦还可以引起肾脏的直接反应,即减少升压化学物质的释放,增加钠的排泄。
International Circulation:But if we’re talking about town of a million in China — of which there are, I think, over 100 — how expensive is this treatment?
《国际循环》:但是如果是中国一百万以上人口的城市呢——我想中国可能有超过100个这样的城市——这种治疗花费昂贵吗?
PROF BAILEY:Well, that’s an unknown. Certainly the cost of any new technology is greater, but the equipment itself, what it takes in terms of the radiofrequency generator, et cetera, become very inexpensive with multiple uses. Can the systems for the renal artery-designed treatment be reusable, re-sterilizible, much in the same way we use balloon catheters to treat valvular narrowings for multiple uses. All that I think is possible. We’re in the very early part of all of this. If we look back to how we thought the balloon procedure on the coronary arteries was going to be used, we didn’t think it was going to be used very often. Stents in coronaries, we thought maybe six out of every 100 patients would receive a stent. We clearly didn’t figure that one out. And now we’re seeing the new percutaneous valve treatments for heart disease. These really game-changing ideas have come along. I think this is probably another one of those game-changers.
PROF BAILEY:尚不明确。当然,任何新技术的花费都会更高一些,但是这个仪器本身,包括射频发生器等,用途很广泛,因此可以做到价格低廉。为经肾动脉治疗设计的系统可以重复消毒,重复利用,和我们利用球囊导管治疗瓣膜狭窄的方法类似。我想这些都是有可能的。这项治疗的研究和应用目前还处于早期阶段。回顾一下过去我们对冠状动脉球囊扩张术应用前景的看法,当时我们认为这项技术并不会被经常使用,只有百分之六的患者会接受支架植入。很明显,我们当时没有预测准确。现在我们又看到了经皮心脏瓣膜治疗术。过去曾经出现过这些改变疾病治疗策略的构想,我想经皮高血压治疗术也很有可能就是又一个改变现有治疗策略的疗法。
International Circulation:So do you think that in the future this percutaneous treatment is going to replace medicine for the treatment of hypertension totally, or are we not going that far?
《国际循环》:那么您认为将来经皮高血压治疗术是否会完全取代高血压药物治疗呢?
PROF BAILEY:Well, the title of the presentation was pretty provocative, wasn’t it? I’m sure it’s not going to replace medical therapy. I’m sure it’s not going to replace the fact that, if you’re thinner, if you’re on a good diet, if you limit your salt to under five grams a day and you exercise, that you may well avoid needing this at all. We’ve got to keep doing that. But if it comes to people who are having to take two or three or five medications daily over a long period of time, the cost of a single treatment and the compliance issues, which go away, may really have a significant impact on how we choose, and how our patients, more importantly, choose, to have their blood pressure problems treated.
PROF BAILEY:这个报告的题目非常有鼓动性,不是吗?我很确定它并不会取代药物治疗。也很确信它不会取代良好生活方式的作用——如果你能够减肥,保持合理饮食,把每天盐摄入量控制在5克以内,并且规律体力活动,可能就根本用不着这些治疗,我们也一直在鼓励患者这样做。但是对于不得不长期每天吃两三种到五种降压药的患者,单次治疗在花费和依从性方面的优势就会影响我们对治疗方式的选择,而且更重要的是,会影响我们的患者在选择高血压治疗方式的选择。
International Circulation:Thank you very much. I think that’s all.
PROF BAILEY:不客气。
PROF BAILEY:You’re quite welcome.
《国际循环》:非常感谢您接受我们的采访。