球囊肺动脉成形术治疗慢性血栓栓塞性肺动脉高压的效果和安全性  

Efficacy and safety of Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension

作　　者：陶新曹[1] 彭文华[2] 谢万木[3] 万钧[3] 刘敏[4] 高柳 高倩[3] 张帅[3] 翟振国[3] 王辰[1] Tao Xincao;Peng Wenhua;Xie Wanmu;Wan Jun;Liu Min;Gao Liu;Gao Qian;Zhang Shuai;Zhai Zhenguo;Wang Chen(Chinese Academy of Medical Sciences,Graduate School of Peking Union Medical College,Beijing 100730,China;Department of Cardiology,China-Japan Friendship Hospital,Beijing 100029,China;Department of Pulmonary and Critical Care Medicine,China-Japan Friendship Hospital,Beijing 100029,China;Department of Radiology,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中国医学科学院北京协和医学院研究生院,北京100730 [2]中日友好医院心脏内科,北京100029 [3]中日友好医院呼吸与危重症医学科,北京100029 [4]中日友好医院放射诊断科,北京100029

出　　处：《中华医学杂志》2020年第6期437-441,共5页National Medical Journal of China

基　　金：国家自然科学基金(81871328,81570049);国家自然科学基金青年科学基金项目(81600036);北京市自然科学基金(7182149)。

摘　　要：目的评价球囊肺动脉成形术(BPA)治疗慢性血栓栓塞性肺动脉高压(CTEPH)的效果和安全性。方法连续入选2018年2月至2019年9月在中日友好医院呼吸中心住院的CTEPH患者,所有患者经多学科讨论确定无法行肺动脉血栓内膜剥脱术(PEA),具有BPA手术指征。BPA术前评估6 min步行距离(6MWD)、检测血N-末端脑钠肽前体(NT-proBNP)水平,行右心导管检查获得混合静脉血氧饱和度、平均肺动脉压(mPAP)、心指数和肺血管阻力(PVR),将BPA治疗前与最后一次BPA时各项参数进行对比分析。结果行BPA治疗的CTEPH患者25例,共行67例次BPA治疗,其中男10例(40.0%),女15例(60.0%),年龄(57.8±7.1)岁,诊断CTEPH到BPA治疗间隔时间20.0(9.0,48.5)个月,共治疗肺动脉302支,18例患者BPA≥2次,术后随访时间5.0(3.5,8.3)个月,术后6MWD、心指数、混合静脉血氧饱和度均显著改善[(425±74)比(345±109)m、(1.99±0.45)比(1.62±0.35)L·min-1·m-2、(68.1±6.5)%比(61.2±6.3)%](均P<0.05),术后血浆NT-proBNP、mPAP、PVR均显著低于术前[259(93,739)比806(148,2159)ng/L、(40.6±8.3)比(47.3±10.7)mmHg(1 mmHg=0.133 kPa)、(11.9±4.9)比(17.2±6.5)WU(1 WU=80 dyn·s·cm-5)](均P<0.05)。咯血5例次(7.5%),再灌注肺水肿(RPE)2例次(1.5%);1例因RPE需无创呼吸机治疗,1例围手术期因咯血加重右心衰竭导致死亡。结论BPA能显著改善不能行PEA的CTEPH患者的运动耐量和血流动力学参数,手术并发症发生率较低,安全有效。Objective To study the efficacy and safety of Balloon pulmonary angioplasty(BPA)for chronic thromboembolic pulmonary hypertension(CTEPH).Methods Patients who were diagnosed CTEPH in China-Japan Friendship Hospital from Feb 2018 to Sep 2019 were evaluated.The ineligibility for pulmonary endarterectomy(PEA)and the indication for BPA were decided on the basis of a consensus among the multidisciplinary team for all CTEPH patients.6-min walk distance(6MWD),the plasma level of N-terminal pro-brain natriuretic peptide(NT-proBNP),mixed venous oxygen saturation,mean pulmonary artery pressure(mPAP),cardiac index(CI)and pulmonary vascular resistance(PVR)were collected and analyzed before the first and the last BPA session.Results A total of 67 BPA sessions were performed for 302 subsegmental pulmonary arteries in 25 inoperable CTEPH patients.10 males(40.0%)and 15 females(60.0%),with the age of(57.8±7.1)years old.The median interval between CTEPH diagnosis and first BPA was 20.0(9.0,48.5)months.18 patients were received more than 2 BPA sessions,the median follow-up time was 5.0(3.5,8.3)months.6MWD,CI and the mixed venous oxygen saturation were significant improved after BPA[(425±74)vs(345±109)m,(1.99±0.45)vs(1.62±0.35)L·min-1·m-2,(68.1%±6.5%)vs(61.2%±6.3%)](all P<0.05).The plasma level of NT-proBNP,mPAP and PVR were significantly decreased after BPA[259(93,739)vs 806(148,2159)ng/L,(40.6±8.3)vs(47.3±10.7)mmHg(1 mmHg=0.133 kPa),(11.9±4.9)vs(17.2±6.5)WU(1 WU=80 dyn·s·cm-5)](all P<0.05).Hemoptysis occurred in 5 sessions(7.5%)and reperfusion pulmonary edema(RPE)occurred in 2 sessions(1.5%),1 patient needed non-invasive mechanical ventilation because of RPE,1 patient died from right heart failure caused by hemoptysis during perioperative period.Conclusions BPA can significantly improve the exercise tolerance and hemodynamic parameters for inoperable CTEPH patients,the risks of BPA are acceptable.BPA is an effective and relatively safe treatment for inoperable CTEPH patients.

关 键 词：肺血栓栓塞症 肺动脉高压 球囊肺动脉成形术 治疗结果 

分 类 号：R544[医药卫生—心血管疾病]