摘要
目的探讨病变位置适合肺动脉内膜剥脱术(PEA)的慢性血栓栓塞性肺动脉高压(CTEPH)患者接受球囊肺动脉扩张成形术(BPA)治疗的疗效和安全性。方法本研究为观察性研究,采用非随机抽样的方法选取首都医科大学附属北京朝阳医院呼吸与危重症医学科2020年1月至2022年1月收治的病变位置适合PEA,但由于各种原因未行手术而接受BPA治疗的10例CTEPH患者为研究对象。收集并比较CTEPH患者接受BPA治疗前和最后1次BPA结束后1~3个月随访时右心导管检查得到的血流动力学指标[包括右心房压力、平均肺动脉压(mPAP)、肺血管阻力、心输出量、每搏输出量、右室每搏功指数和心指数]、世界卫生组织(WHO)功能分级、6分钟步行距离,以及超声心动图指标(包括左心室舒张末内径、左心室射血分数、肺动脉主干宽度、右心室基底内径、右心室前壁厚度、右心室面积变化分数、三尖瓣环收缩期位移、心肌做功指数、右心房横径和三尖瓣反流速度)。记录患者的BPA治疗次数、球囊扩张血管数和BPA并发症发生情况。结果本研究10例CTEPH患者中,男5例(50%),女5例(50%),年龄(66.4±8.0)岁。BPA治疗后,CTEPH患者的mPAP、肺血管阻力和右心室每搏功指数较治疗前均下降[(38.9±12.7)mmHg(1 mmHg=0.133 kPa)比(52.9±13.8)mmHg,(532.5±256.5)dyn·s·cm_(-5)比(857.3±297.8)dyn·s·cm_(-5),(17.2±6.9)g·m/m_(2)比(19.2±7.4)g·m/m_(2),均P<0.05];心输出量、心指数和6分钟步行距离较治疗前均升高[(4.6±1.0)L/min比(4.0±0.8)L/min,(2.6±0.5)L/(min·m_(2))比(2.3±0.4)L/(min·m_(2)),438.0(369.0,461.0)m比356.0(0.0,431.0)m,均P<0.05];WHO功能分级较治疗前改善,差异有统计学意义(Z=2.59,P=0.010);CTEPH患者的左心室舒张末内径、右心室面积变化分数和三尖瓣环收缩期位移较治疗前均增大[(46.8±3.6)mm比(43.0±6.3)mm,(40.7±10.8)%比(33.3±9.5)%,(18.0±3.4)mm比(14.6±3.2)mm,均P<0.05],右心室基底内径和三尖
ObjectiveTo investigate the effectiveness and safety of balloon pulmonary angioplasty(BPA)on chronic thromboembolic pulmonary hypertension(CTEPH)with the location of lesions suitable for pulmonary endarterectomy(PEA).MethodsThis was an observational study.Ten CTEPH patients admitted in the Department of Respiratory and Critical Care Medicine,Beijing Chaoyang Hospital,Capital Medical University from January 2020 to January 2022,who had the lesions located in suitable locations for PEA but treated with BPA for other reasons were enrolled using the non-random sampling.Hemodynamic parameters obtained from right heart catheterization in CTEPH patients before BPA and during the follow-up period of 1-3 months after the last BPA were collected,including right atrial pressure,mean pulmonary artery pressure(mPAP),pulmonary vascular resistance,cardiac output,stroke volume,right ventricular stroke work index(RVSWI),and cardiac index were compared.In addition,the World Health Organization(WHO)functional classification,6-minute walking distance(6MWD),and echocardiographic parameters,including the left ventricular end diastolic diameter(LVEDD),left ventricular ejection fraction,pulmonary artery trunk width,right ventricular basal diameter,right ventricular anterior wall thickness,right ventricular area change fraction,tricuspid annular plane systolic excursion,myocardial work index,right atrial transverse diameter,and tricuspid regurgitation velocity were compared.The number of BPA,the number of balloon dilation vessels,and the incidence of BPA complications were recorded.ResultsIn this study,a total of 10 CTEPH patients were recruited,with a mean age of(66.4±8.0)years,containing 5 men(50%)and 5 women(50%).After BPA,the mPAP([38.9±12.7]mmHg vs[52.9±13.8]mmHg,1 mmHg=0.133 kPa),pulmonary vascular resistance([532.5±256.5]dyn·s·cm_(-5) vs[857.3±297.8]dyn·s·cm_(-5))and RVSWI([17.2±6.9]g·m/m_(2) vs[19.2±7.4]g·m/m_(2))of CTEPH patients were all reduced compared with before treatment(all P<0.05).Cardiac output([4.6±1.0]L/
作者
汪薇
丁媛
杨媛华
Wang Wei;Ding Yuan;Yang Yuanhua(Department of Geriatrics,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China;Beijing Institute of Respiratory Medicine,Department of Respiratory and Critical Care Medicine,Beijing Chao-Yang Hospital,Capital Medical University,Beijing100020,China)
出处
《国际呼吸杂志》
2024年第10期1157-1163,共7页
International Journal of Respiration
基金
国家重点研发计划(2023YFC2507200)。
