摘要
目的:旨在初步评价经皮房间隔造瘘术治疗顽固性左心衰竭患者的短期血流动力学效果。方法:入选2019年10月至2020年7月期间在阜外医院心力衰竭重症监护病区(HFCU)住院的成年顽固性心力衰竭(心衰)患者,包括射血分数保降低的心衰(HFrEF)和射血分数保留的心衰(HFpEF)。入选标准包括目前纽约心脏协会(NYHA)心功能分级Ⅱ级或Ⅲ级,入院时收缩压>100 mmHg(1 mmHg=0.133 kPa),经优化药物治疗和强化容量管理1周后行Swan-Ganz漂浮导管测量静息状态下肺小动脉楔压(PAWP)>15 mmHg,运动后PAWP>25 mmHg。收集患者术前基线资料,包括6分钟步行距离(6MWT)、N末端B型利钠肽前体(NT-proBNP)、超声心动图指标及Swan-Ganz漂浮导管数据。经右股静脉行房间隔穿刺,在压力监测下行球囊扩张,完成房间隔造瘘术。术后监测生命体征变化及并发症,术后24 h内经Swan-Ganz漂浮导管测量右心房压(RAP)、肺动脉压(PAP)、PAWP及心输出量(CO),并计算心脏指数(CI)。术后48~72 h复查6MWT、NT-proBNP及超声心动图。结果:共入选3例左心衰患者,1例女性,为HFpEF患者,2例男性,为HFrEF患者。NYHA心功能分级均为Ⅲ级。3例患者均成功行房间隔造瘘术,术后生命体征平稳,无并发症发生。3例患者术后NYHA心功能分级均将为Ⅰ级,第2例和第3例患者的6MWT分别增加了90 m和80 m,但两例患者术后NT-proBNP水平均出现短暂升高。3例患者房间隔造瘘术前后超声心动图指标未见明显变化。Swan-Ganz漂浮导管测量数据显示,3例患者术后PAP(分别为28 mmHg、23 mmHg和12 mmHg)及PAWP(分别为17 mmHg、13 mmHg和11 mmHg)均较术前(PAP:29 mmHg、26 mmHg和34 mmHg,PAWP:23 mmHg、20 mmHg和27 mmHg)下降。除第2例患者(HFpEF)术后CO(3.0 L/min)和CI(1.72 L·min^-1·m^-2)较术前(CO:3.5 L/min,CI:2.01 L·min^-1·m^-2)下降外,其余2例(HFrEF)患者术后CO(分别为5.5 L/min和3.4 L/min)及CI(分别为2.61 L·min^-1·m^-2和2.02 L·min^-1·m^-2)均较�
Objective:To preliminarily evaluate the short-term hemodynamic effects of percutaneous atrial septostomy on patients with refractory left heart failure.Methods:Patients hospitalized in the Heart Failure Care Unit(HFCU)of Fuwai Hospital between October 2019 and July 2020 with refractory heart failure,including heart failure with reduced ejection fraction(HFrEF)and heart failure with preserved ejection fraction(HFpEF),were enrolled.The inclusion criteria included current New York Heart Association(NYHA)functional class II or III,systolic blood pressure on admission>100 mmHg,and raised pulmonary arterial wedge pressure(PAWP)at rest(>15 mmHg)and during exercise(>25 mmHg)detected by Swan-Ganz catheterization after optimal medication and intensive volume management for one week.Preoperative baseline data,including 6-minute walking distance(6MWT),N terminal pro-B type natriuretic peptide(NT-proBNP),echocardiographic parameters and hemodynamic parameters detected by Swan-Ganz catheter were collected.After transseptal puncture via right femoral vein approach,atrial septostomy was performed through balloon dilation under pressure monitoring.Postoperative changes of vital signs and occurrence of potential complications were closely monitored.Right atrial pressure(RAP),pulmonary artery pressure(PAP),PAWP and cardiac output(CO)were detecterd by use of Swan-Ganz catheter and cardiac index(CI)was calculated within 24 h and 6MWT,NT-proBNP and ehocardiography were repeated within 48~72 h after atrial septostomy.Results:A total of 3 patients were enrolled with 1 female of HFpEF and 2 males of HFrEF.All 3 patients underwent atrial septostomy successfully and the postoperative vital signs were stable without complications.The NYHA functional class decreased from preoperative III to postoperative I for all 3 patients.6MWT in the 2 nd and 3 rd patient increased by 90 m and 80 m,respectively,while the postoperative NT-proBNP levels among these 2 patients showed a transient increase.There was no significant change in echocardiographic p
作者
毛懿
安涛
周琼
翟玫
王运红
张宇辉
张健
Mao Yi;An Tao;Zou Qiong;Zai Mei;Wang Yunhong;Zhang Yuhui;Zhang Jian(Heart Failure Care Unit(HFCU),Heart Failure Center,Fuwai Hospital,National Center for Cardiovascular Disease,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)
关键词
左心衰竭
顽固性
房间隔造瘘术
经皮
血流动力学
临床症状
心功能分级
Left heart failure,refractory
Atrial septostomy,percutaneous
Hemodynamics
Clincal symptom
Functional class