摘要
目的:探讨术后残存堵塞肺段数对肺动脉血栓内膜剥脱术效果的影响。方法:收集87例本中心诊断为慢性血栓栓塞性肺动脉高压(CTEPH)并接受肺动脉血栓内膜剥脱术(PTE)患者的完整临床资料。先根据术后CT提示残存堵塞肺段数将患者分为0~2段组、3~4段组、5~6段组和7~8段组;再根据出现明显血流动力学变化差异的残存堵塞肺段数临界值,将患者分为肺血栓残存过多组及肺血栓残存理想组。分析肺血栓残存程度对术后血流动力学的影响,探讨总结影响肺血栓残存程度的可能危险因素。结果:术后残存堵塞肺段数在0~2个为理想的残存堵塞肺段数,其能为患者带来最佳的血流动力学改善结果。86例术后存活患者中共66例(76.7%)患者为肺血栓残存理想组,20例(23.3%)患者为肺血栓残存过多组,肺血栓残存理想组在改善患者术后血流动力学及三尖瓣反流方面均明显优于后者(P<0.05)。单因素分析提示手术年份(OR=0.905,95%CI:0.825~0.994,P=0.037)及术前合并深静脉血栓性疾病患者(OR=0.261,95%CI:0.089~0.768,P=0.015)是影响肺血栓残存程度的主要保护性因素。多因素危险因素分析结果提示术前合并深静脉血栓性疾病患者为影响剥脱肺血栓残存分组的主要保护性影响因素(OR=0.289,95%CI:0.096~0.868,P=0.027)。结论:对于术前合并深静脉血栓病史的患者往往能在术后获得理想数量的残存血栓。而对于手术开展时间不长的中心,在收治无明显深静脉血栓病史的患者,需谨慎安排手术。
Objectives:To investigate the influence of the number of residual occluded pulmonary segment after pulmonary thromboendarterectomy on the hemodynamic improvement for patients with chronic thromboembolic pulmonary hypertension,and to analyze the associated factors that may affect the residual occluded pulmonary embolism segments.Methods:The clinical data of 87 patients with chronic thromboembolic pulmonary hypertension was included into this study,and the peri-operative computed tomography(CT) and right heart catheter results were collected.The changes of pulmonary artery pressure、pulmonary vascular resistance and the number of remaining occluded pulmonary segments after operation were analyzed.According to the number of remaining occluded pulmonary segmental arteries implied by CT scanning,patients were divided into remaining occluded pulmonary segments 0-2 group,3-4 group,5-6 group and 7-8 group and then divided into unsatisfactory pulmonary embolism remaining occluded group,and ideal pulmonary embolism remaining occluded group.Results:An ideal number of remaining occluded pulmonary segments is 2 or less,which could bring the best hemodynamic improvement result post-surgery in this patient cohort.According to post-operative computed tomography scanning result,66 cases of patients belonged to the ideal pulmonary embolism remaining occluded group(76.7%,66/86),and only 20 of them belonged to the unsatisfactory pulmonary embolism remaining occluded group(23.3%,20/86).The ideal pulmonary embolism remaining occluded group was superior to the terrible pulmonary embolism remaining occluded group as regard to the improvement of hemodynamic result and tricuspid regurgitation.Univariate analysis showed that the history of DVT(OR=0.261,95%CI:0.089-0.768,P=0.015) and surgery years(OR=0.905,95%CI:0.825-0.994,P=0.037) were the determinants on the incidence of incomplete stripping surgery.Multivariate analysis showed that the history of DVT was the strongest protective factor on the incidence of incomplete stripping surgery(O
作者
朱家德
王海苹
邓隆
宋武
蒋鑫
刘盛
宋云虎
杜娟
陈伊
ZHU Jiade;WANG Haiping;DENG Long;SONG Wu;JIANG Xin;LIU Sheng;SONG Yunhu;DU Juan;CHEN Yi(Cardiac Surgery)
出处
《中国循环杂志》
CSCD
北大核心
2019年第8期790-795,共6页
Chinese Circulation Journal
基金
中国医学科学院医学与健康科技创新工程(2017-I2M-3-003)
首都临床特色应用研究与成果推广(Z171100001017215)
关键词
肺动脉血栓内膜剥脱术
术后结果
影响因素
肺血栓残存程度
pulmonary thromboendarterectomy
post-operative result
influence factor
residual pulmonary embolism state
