慢性血栓栓塞性肺动脉高压患者行球囊肺动脉成形术后运动心肺功能的变化  

The Effect of Balloon Pulmonary Angioplasty on Exercise Cardiopulmonary Function in Patients with Chronic Thromboembolic Pulmonary Hypertension

作　　者：赵智慧[1] 罗勤[1] 柳志红[1] 杨涛[1] 金旗[1] 熊长明 赵青[1] 曾绮娴[1] 马秀平[1] 何建国[1] ZHAO Zhi-hui;LUO Qin;LIU Zhi-hong;YANG Tao;JIN Qi;XIONG Chang-ming;ZHAO Qing;ZENG Qi-xian;MA Xiu-ping;HE Jian-guo(Center for Pulmonary Vascular Diseases,National Center for Cardiovascular Disease and Fuwai Hospital,CAMS and PUMC,Beijing 100037,China)

机构地区：[1]中国医学科学院,北京协和医学院国家心血管病中心,阜外医院肺血管病中心,北京市100037

出　　处：《中国分子心脏病学杂志》2019年第6期3137-3139,共3页Molecular Cardiology of China

基　　金：国家重点研发计划(2016YFC0905602)。

摘　　要：目的探讨球囊肺动脉成形术(BPA)对慢性血栓栓塞性肺动脉高压(CTEPH)患者的运动心肺功能的影响。方法连续入选2018年5月至2019年1月于我中心行BPA治疗的31例CTEPH患者。收集患者的性别、年龄、体重指数、症状持续时间、心功能分级、6分钟步行距离(6MWD)、血浆中氨基末端B型脑钠肽前体(NT-proBNP)的表达水平等资料。行右心导管检查,测定肺血管血流动力学参数,并行肺动脉造影检查和BPA。在BPA术前和术后1~3 d行心肺运动检查。结果31例CTEPH患者接受BPA治疗50例次,其中男性16人,女性15人,平均年龄(57.0±11.4)岁(25~76)岁,体重指数(23.7±3.4)kg/m2,症状持续时间(4.26±4.21)年。WHO心功能分级Ⅲ级19例次(38%),II级29例次(58%),I级2例次(4%)。患者平均扩张3.5支(1~9支)肺段动脉,4.7支(1~9支)亚段动脉,行BPA后,肺动脉收缩压、肺动脉舒张压、肺动脉平均压和NT-proBNP显著下降,WHO心功能分级和6MWD显著改善。无严重并发症发生。BPA前后,心肺运动的参数:峰值摄氧量占预计值%,无氧阈值,最大氧脉搏、二氧化碳排出通气斜率、摄氧效率斜率均有显著改善,有统计学差异。结论行BPA的CTEPH患者术后运动心肺功能明显改善。Objective To evaluate the effect of balloon pulmonary angioplasty(BPA)on exercise cardiopulmonary function in patients with chronic thromboembolic pulmonary hypertension(CTEPH).Methods From May 2018 to January.2019,fifty procedures in 31 patients with CTEPH were selected for BPA treatment in our center.The sex,age,body mass index(BMI),symptom duration,WHO functional class,6-minute walking distance(6MWD)and the expression of N-terminal B-type brain natriuretic peptide precursor(NT-proBNP)in plasma were collected.Right heart catheterization was performed to determine pulmonary vascular hemodynamic parameters,pulmonary angiography and BPA were also performed.Cardiopulmonary exercise examination was performed before BPA and 1-3 d after operation.Results Fifty procedures in patients with CTEPH were treated with BPA,including 16 males and 15 females,with an average age of(57.0±11.4)years(25-76 years)and(BMI)of(23.7±3.4)kg/m2,for(4.26±4.21)years.There were 19 procedures of WHO III class(38%),29 procedures of WHO II class(58%),2 procedures of WHO I class(4%).An average of 3.5(1-9)segmental pulmonary arteries and 4.7(1-9)subsegmental arteries were dilated.after BPA,pulmonary artery systolic pressure,pulmonary artery diastolic pressure,mean pulmonary artery pressure and the plasma concentrations of NT-proBNP decreased significantly.WHO function class and 6MWD were significantly improved.No serious complications occurred.Before and after BPA,the parameters of cardiopulmonary exercise testing:peak oxygen uptake%,anaerobic threshold,maximum oxygen pulse,carbon dioxide exhaust ventilation slope,oxygen uptake efficiency slope were significantly improved,there were statistical differences.Conclusions The exercise cardiopulmonary function of CTEPH patients was improved after BPA.

关 键 词：慢性血栓栓塞性肺动脉高压 球囊肺动脉成形术 运动心肺功能 

分 类 号：R654.3[医药卫生—外科学]