肺通气/灌注显像对肺动脉血栓内膜剥脱术后残余肺动脉高压的评价  

Pulmonary ventilation/perfusion scintigraphy in assessing residual pulmonary hypertension after pulmonary endarterectomy

作　　者：汪蕾[1] 王蒙 张宗耀[1] 张海龙 方纬[1] Wang Lei;Wang Meng;Zhang Zongyao;Zhang Hailong;Fang Wei(Department of Nuclear Medicine,Chinese Academy of Medical Sciences&Fuwai Hospital,National Center for Cardiovascular Diseases,Beijing 100037,China)

机构地区：[1]国家心血管病中心、中国医学科学院阜外医院核医学科,北京100037

出　　处：《中华核医学与分子影像杂志》2021年第5期257-261,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探讨慢性血栓栓塞性肺动脉高压(CTEPH)患者肺动脉血栓内膜剥脱术术前全肺灌注缺损百分比(PPDs%)与术后残余肺动脉高压发生的相关性。方法回顾性分析2016年1月至2019年1月于阜外医院行肺动脉血栓内膜剥脱术并于术前术后均行核素肺通气/灌注(V/Q)显像的37例CTEPH患者[男21例、女16例,年龄(50±12)岁]。将术后肺动脉平均压(mPAP)高于30 mmHg(1 mmHg=0.133 kPa)患者归入残余肺动脉高压组,余归入无残余肺动脉高压组。计算PPDs%用以代表全肺血流灌注缺损程度,探讨术前术后肺动脉压力阻力及肺血流灌注的变化,采用logistic回归分析影响残余肺动脉高压发生的因素。另采用配对t检验及两独立样本t检验分析数据。结果肺动脉血栓内膜剥脱术明显降低mPAP[(50.22±11.72)与(26.41±10.61)mmHg;t=12.599,P<0.001]、肺血管阻力[(10.06±5.48)与(2.89±1.58)Wood单位;t=8.086,P<0.001],减少灌注缺损肺段数[(13.79±2.11)与(5.52±2.82)个;t=11.593,P<0.001]。残余肺动脉高压组患者(11例)术前PPDs%明显高于无残余肺动脉高压组[26例;(57.48±5.88)%与(47.77±11.09)%;t=-3.458,P=0.002]。多因素回归分析结果提示,术前PPDs%是影响术后残余肺动脉高压的主要因素[比值比(OR)=1.106,95%CI:1.006~1.216,P=0.036]。结论核素肺V/Q显像可反映肺动脉血栓内膜剥脱术疗效,术前全肺血流灌注缺损程度是术后残余肺动脉高压发生的影响因素。Objective To analyze the relationships between baseline percentage of pulmonary perfusion defect scores(PPDs%)and residual pulmonary hypertension after pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension(CTEPH)patients.Methods A total of 37 CTEPH patients(21 males,16 females,age(50±12)years)who had pre-and post-pulmonary endarterectomy ventilation/perfusion(V/Q)scans from January 2016 to January 2019 at Fuwai Hospital were retrospectively collected.Residual pulmonary hypertension was defined as post-surgery mean pulmonary artery pressure(mPAP)higher than 30 mmHg(1 mmHg=0.133 kPa).Semi-quantitative index PPDs%was calculated to represent the extent of impaired perfusion in the whole lung.Pre-and post-surgery pulmonary hemodynamic parameters including pulmonary arterial pressure and resistance and lung perfusion were compared.Factors that may be related residual pulmonary hypertension were analyzed using logistic regression analysis.Paired t test and independent-sample t test were also used.Results Pulmonary endarterectomy significantly decreased mPAP((50.22±11.72)vs(26.41±10.61)mmHg;t=12.599,P<0.001)and pulmonary vascular resistance((10.06±5.48)vs(2.89±1.58)Wood unit;t=8.086,P<0.001).The number of defected lung segments(13.79±2.11 vs 5.52±2.82;t=11.593,P<0.001)was significantly reduced.Patients who had residual pulmonary hypertension(n=11)exhibited significantly higher PPDs%before the surgery compared to those who were without residual pulmonary hypertension(n=26;(57.48±5.88)%vs(47.77±11.09)%;t=-3.458,P=0.002).Baseline PPDs%was an independent factor for predicting residual pulmonary hypertension after pulmonary endarterectomy(odds ratio(OR)=1.106,95%CI:1.006-1.216,P=0.036).Conclusions Pulmonary V/Q scan can assess the therapeutic effects of pulmonary endarterectomy.Extent of impaired lung perfusion assessed by V/Q scan is the influencing factor for post-surgery residual pulmonary hypertension.

关 键 词：肺动脉 血栓形成 动脉内膜切除术 高血压 肺性 通气/灌注显像 99m锝聚集白蛋白 99m锝高锝酸钠 

分 类 号：R654.2[医药卫生—外科学]