摘要
目的总结球囊肺动脉成形术(BPA)治疗不能外科手术的慢性血栓栓塞性肺动脉高压(CTEPH)的疗效和安全性。方法回顾性分析2018年2月至2021年12月阜外华中心血管病医院19例CTEPH患者因不能行肺动脉血栓内膜剥脱术(PEA)而进行BPA治疗的临床资料,比较BPA治疗前后世界卫生组织(WHO)心功能、肺动脉压力和右心大小的变化。结果入组患者平均年龄(56.6±12.2)岁,男8例(8/19);共接受38次BPA治疗。与BPA治疗前相比,BPA后患者的6 min步行试验距离[(418.1±20.6)m比(351.1±33.6)m,P<0.001]和心输出量[(3.9±0.8)L/min比(3.4±1.7)L/min,P=0.048]增加,N末端B型脑钠肽前体[(767.5±149.0)pg/ml比(2777.5±463.2)pg/ml,P<0.001]、肺血管阻力[(9.4±2.3)Wood单位比(14.4±4.5)Wood单位,P<0.001]和平均肺动脉压[(35.3±1.4)mmHg比(44.8±2.2)mmHg(1mmHg=0.133kPa),P<0.001]下降,右心室基底内径[(25.4±1.0)mm比(30.0±0.9)mm,P<0.001]和右心房左右径[(46.5±1.9)mm比(53.7±1.9)mm,P<0.001]减小,差异均有统计学意义。BPA后共发生4例次(4/38)并发症。结论对于不能行PEA的CTEPH患者,BPA可有效降低肺动脉压力,改善肺灌注,增加心输出量,且并发症发生率低,是CTEPH患者较为有效的治疗方法之一。
Objective To summarize the efficacy and safety of pulmonary balloon angioplasty(BPA)in patients with inoperable chronic thromboembolic pulmonary hypertension(CTEPH).Methods The clinical data of 19 CTEPH patients without the indication of pulmonary endarterectomy who were treated with BPA were analyzed retrospectively.The patients were hospitalized in Fuwai Central China Cardiovascular Hospital from February 2018 to December 2021.The cardiac function,pulmonary artery pressure and the size of right heart before and after the treatment of BPA were compared.Results The average age of all patients was(56.6±12.2)years old,with 8(8/19)of male.A total of 38 times of BPA treatments were received.Compared with the clinical data before BPA,6-minute walking distance[(418.1±20.6)m vs.(351.1±33.6)m,P<0.001]and cardiac output[(3.9±0.8)L/min vs.(3.4±1.7)L/min,P=0.048]were increased,N-terminal B-type natriuretic peptide[(767.5±149.0)pg/ml vs.(2777.5±463.2)pg/ml,P<0.001],pulmonary vascular resistance[(9.4±2.3)Wood unit vs.(14.4±4.5)Wood unit,P<0.001]and mean pulmonary artery pressure[(35.3±1.4)mmHg vs.(44.8±2.2)mmHg,P<0.001]were decreased,right ventricular basal diameter[(25.4±1.0)mm vs.(30.0±0.9)mm,P<0.001 and right atrial diameter[(46.5±1.9)mm vs.(53.7±1.9)mm,P<0.001]were reduced after the treatment of BPA,in which the difference was statistically significant(P<0.05).Complication occurred in 4 times(4/38)of BPA treatment.Conclusions BPA can effectively reduce pulmonary artery pressure,improve pulmonary perfusion and increase cardiac output in CTEPH patients who cannot undergo pulmonary artery thrombus endarterectomy,and has a low incidence of complication.It is one of the more effective treatment methods for CTEPH patients.
作者
蔡连卫
程江涛
孙子瑞
郭晓燕
吴艳芳
张晶晶
CAI Lian-wei;CHENG Jiang-tao;SUN Zi-rui;GUO Xiao-yan;WU Yan-fang;ZHANG Jing-jing(Department of Cardiology,Fuwai Central China Cardiovascular Hospital,Zhengzhou 451464,China)
出处
《中国介入心脏病学杂志》
2022年第12期898-902,共5页
Chinese Journal of Interventional Cardiology
关键词
慢性血栓栓塞性肺动脉高压
球囊肺动脉成形术
疗效
Chronic thromboembolic pulmonary hypertension
Balloon pulmonary angioplasty
Efficacy
