臺灣博碩士論文加值系統

腎動脈狹窄易引發高血壓，導致心血管疾病甚至致死，好發於老年與肥胖族群。近年來相關研究逐漸抬頭，其中非藥物治療的腎交感神經阻斷術被廣泛使用於臨床治療，透過射頻電流的熱效應將腎動脈上的交感神經叢連結燒灼，使神經支配降低以達到降低高血壓的效果。然而一份研究顯示此方法並非有效治療，探究原因之餘，尋找替代方法也刻不容緩。
觀察到脈衝射頻電刺激具有阻斷神經傳導的作用，本研究提出脈衝射頻電刺激能抑制腎動脈狹窄引發之高血壓的假說，將脈衝射頻電刺激使用在外力致使腎動脈狹窄或假操作的Sprague-Dawley大鼠模型上，紀錄各階段尾部回流動脈血壓，分析進行確效驗證，最終結果支持研究假說—脈衝射頻電刺激確實能抑制腎動脈狹窄引發之高血壓。

Treating Renal Artery Stenosis induced Hypertension, including Renovascular Hypertension, also called Renal Hypertension, and Resistant Hypertension, has been popular in several years, for severe Hypertension could result in cardiovascular disease, leading patient to death. Recently, clinically used Renal Sympathetic Denervation (RSD) has been proved not an effective treatment on Resistant Hypertension, alternative methods are urgently needed. In this Research, we hypothesized that Pulsed Frequency (PRF) electrical stimulation could suppress Renal Artery Stenosis induced Hypertension, for PRF is capable of blocking nerve transmission. We applied PRF on Sprague-Dawley rats which went through Renal Artery Oppressing surgery or sham surgery, recorded blood pressure information individually in every stage, and validated this method with some analysis. The result turned out to suggest the hypothesis, showing that PRF on narrowed Renal Artery could suppress Renal Artery Stenosis induced Hypertension.

口試委員會審定書 I
誌 謝 II
摘 要 IV
ABSTRACT V
目 錄 VI
圖目錄 VIII
表目錄 X
第1章 緒 論 1
1.1 研究背景 1
1.2 研究動機 2
1.3 研究貢獻 2
1.4 論文架構 2
第2章 基本原理與文獻回顧 3
2.1 腎動脈狹窄引發高血壓 3
2.2 脈衝射頻電刺激 8
2.3 脈衝射頻電刺激於腎血管性高血壓之應用 12
第3章 實驗設計 13
3.1 使用儀器 13
3.2 實驗動物 15
3.3 實驗安排 16
3.4 實驗操作 18
第4章 數據分析 27
4.1 實驗結果 27
4.2 數據分析 31
4.3 統計分析 33
4.4 與現有研究比較 38
第5章 結論、討論與未來展望 42
5.1 結論 42
5.2 討論與未來展望 43
參考文獻 44

1.洪尉欽, 腎動脈狹窄 腎血管性高血壓的元凶, in 義大醫療醫訊. 2012.
2.Calhoun, D.A., et al., Resistant Hypertension: Diagnosis, Evaluation, and Treatment. A Scientific Statement From the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research, 2008. 117(25): p. e510-e526.
3.Pimenta, E. and D.A. Calhoun, Resistant Hypertension: Incidence, Prevalence and Prognosis. Circulation, 2012. 125(13): p. 1594-1596.
4.Bhatt, D.L., et al., A controlled trial of renal denervation for resistant hypertension. N Engl J Med, 2014. 370(15): p. 1393-401.
5.Urban, D., et al., Treating resistant hypertension: role of renal denervation. Integr Blood Press Control, 2013. 6: p. 119-28.
6.Chua, N.H., K.C. Vissers, and M.E. Sluijter, Pulsed radiofrequency treatment in interventional pain management: mechanisms and potential indications-a review. Acta Neurochir (Wien), 2011. 153(4): p. 763-71.
7.DiBona, G.F. and U.C. Kopp, Neural control of renal function. Physiological Reviews, 1997. 77(1): p. 75-197.
8.Goldblatt, H., et al., STUDIES ON EXPERIMENTAL HYPERTENSION : I. THE PRODUCTION OF PERSISTENT ELEVATION OF SYSTOLIC BLOOD PRESSURE BY MEANS OF RENAL ISCHEMIA. The Journal of Experimental Medicine, 1934. 59(3): p. 347-379.
9.Wu, X.C. and E.J. Johns, Nitric Oxide Modulation of Neurally Induced Proximal Tubular Fluid Reabsorption in the Rat. Hypertension, 2002. 39(3): p. 790-793.
10.Garovic, V.D. and S.C. Textor, Renovascular hypertension and ischemic nephropathy. Circulation, 2005. 112(9): p. 1362-74.
11.Ott, C. and R.E. Schmieder, Renal Denervation for Resistant Hypertension: Past, Present, and Future. Curr Hypertens Rep, 2015. 17(8): p. 65.
12.Verloop, W.L., et al., The Effects of Renal Denervation on Renal Hemodynamics and Renal Vasculature in a Porcine Model. PLoS One, 2015. 10(11): p. e0141609.
13.Sluijter, M.E., et al., The effects of pulsed radiofrequency fields applied to the dorsal root ganglion. Pain Clinic, 1998. 11: p. 109-117.
14.Cohen, S.P. and J. Van Zundert, Pulsed radiofrequency: rebel without cause. Regional anesthesia and pain medicine, 2010. 35(1): p. 8-10.
15.Chiu, H.-W., et al., Pain control on demand based on pulsed radio-frequency stimulation of the dorsal root ganglion using a batteryless implantable CMOS SoC. IEEE transactions on biomedical circuits and systems, 2010. 4(6): p. 350-359.
16.Sprott, H., N. Bergamin, and A. Aeschbach, Pulsed radiofrequency therapy might be not inferior to thermal neurotomy in lumbar facet joint pain: a commentary. Rheumatology Reports, 2016. 8(1).
17.Sluijter, M.E., Pulsed Radiofrequency. 2001: FlivoPress.
18.Cahana, A., et al., Pulsed Radiofrequency: Current Clinical and Biological Literature Available. Pain Medicine, 2006. 7(5): p. 411-423.
19.Cosman, E.R. and E.R. Cosman, Electric and Thermal Field Effects in Tissue Around Radiofrequency Electrodes. Pain Medicine, 2005. 6(6): p. 405-424.
20.Kaur, S. and A. Muthuraman, Therapeutic evaluation of rutin in two-kidney one-clip model of renovascular hypertension in rat. Life Sci, 2016. 150: p. 89-94.
21.Kashyap, S., et al., Development of renal atrophy in murine 2 kidney 1 clip hypertension is strain independent. Res Vet Sci, 2016. 107: p. 171-7.
22.Li, P., et al., Renal sympathetic denervation attenuates hypertension and vascular remodeling in renovascular hypertensive rats. Journal of Applied Physiology, 2017. 122(1): p. 121-129.