肺动脉血栓内膜剥脱术治疗慢性栓塞性肺动脉高压及深低温停循环对其疗效的影响  

Treatment of chronic thromboembolic pulmonary hypertension through pulmonary thromboendarterectomy and the effect of deep hypothermia circulation arrest thereon

作　　者：甘辉立[1] 张健群[1] 陈辉[2] 穆军升[1] 周其文[1] 王胜洵[1] 郑斯宏[1] 张向峰[3] 刘双[3] 

机构地区：[1]首都医科大学附属北京安贞医院心外科,100029 [2]北京市房山区第一医院心胸外科 [3]首都医科大学附属北京安贞医院呼吸内科,100029

出　　处：《中华医学杂志》2007年第21期1482-1485,共4页National Medical Journal of China

摘　　要：目的探讨肺动脉血栓内膜剥脱术在治疗慢性栓塞性肺动脉高压中的作用及深低温停循环对其疗效的影响。方法回顾性分析1995年2月至2006年10月应用肺动脉血栓内膜剥脱术治疗慢性栓塞性肺动脉高压40例的诊治资料,其中中心型肺动脉栓塞25例,外周型肺动脉栓塞15例。深低温停循环组17例在深低温停循环下行肺动脉血栓内膜剥脱术,不停循环组23例在不停循环下行肺动脉血栓内膜剥脱术。结果围术期深低温停循环组无死亡,不停循环组6例死亡。术后9例出现残余肺动脉高压,18例出现重度肺组织再灌注损伤。手术前后肺动脉压分别为(91±38)mm Hg(1 mm Hg=0.133 kPa)和(58±31)mm Hg,肺循环阻力分别为(978±676)dynes·sea^(-1)·cm^(-5)和(357±279)dynes-sec^(-1)·cm^(-1)、血氧分压分别为(54±8)mm Hg 升到(90±7)mm Hg、血氧饱和度分别为90.0%±4.3%和96.5%±1.8%,P 均<0.05。34例平均随访(42±36)个月(2～109个月),晚期死亡2例,心功能 NYHA 分级Ⅰ级22例、Ⅱ级9例、Ⅲ级1例。结论深低温停循环有利于进行彻底的肺动脉血栓内膜剥脱术,而防治残余肺动脉高压、肺组织再灌注损伤是提高围术期疗效的关键因素。Objective To evaluate the role of the pulmonary thromboendarterectomy （PTE） in the treatment of chronic thromboembolic pulmonary hypertension （CTEPH） and the effect of the deep hypothermia circulation arrest （DHCA） thereon. Methods The clinical data of 40 cases of CTEPH, 25 cases of central type and 15 cases of peripheral type, 29 males and 11 females, aged 46 ± 12 （20-70）, underwent PTH, 17 under deep hypothermia circulatory arrest （DHCA, Group A） and 23 not under DHCA （Group B） , from February 1995 to October 2006. Follow-up was conducted for 41.8 ± 36. 4 months. Results In the peri-operative period, no patient died in Group A and there were 6 deaths in Group B. 9 suffered with residual pulmonary hypertension and 18 with severe pulmonary reflux injury. 72 h after the VIE, the pulmonary artery systolic pressure （PASP）was 58.3 ±30.7 mm Hg, significantly lower than that before PTS （91.4 ±38.4 mm Hg, P〈0.05） , the pulmonary vascular resistance （PVR） was 357 ±278.7 dynes · sec^-1 · cm^-5, significantly lower than that before PTE （978 ±675.6 dynes · sec^-1 · cm^-5 ,P 〈 0. 01 ） ; the partial pressure of oxygen in the arterial blood （ PaO2 ） was 89.9 ± 7 mm Hg, significantly higher than that before the PTE （54.5 ±7.7 mm Hg, P 〈0.01） ,; and the arterial oxygen saturation （SaO2） was 96.5 ± 1.8% ,significantly higher than that before the PTE （90 ±4. 3% , P 〈0.05）. During the follow-up there were 2 late deaths, and the cardiac function was graded as NYHA class Ⅰ in 22 patients, as NYHA class Ⅱ in 9 patients, and as NYHA class Ⅲ in 1 patient. Conclusion DHCA is a necessary and elementary condition for PTE, and it is a key factor in promoting the effect of VIE to treat the pulmonary reflux injury and residual pulmonary hypertension properly.

关 键 词：肺栓塞 低温 人工 肺动脉 肺动脉血栓内膜剥脱术 再灌注损伤 

分 类 号：R654.2[医药卫生—外科学]