单中心肺动脉内膜剥脱术短期预后及呼吸系统并发症分析  

Short term outcomes and respiratory complications after pulmonary endarterectomy:results from a single Chinese center

作　　者：李晨[1] 马军宇[1] 王书鹏[1] 吴筱箐 翟姗姗 陈德生[1] 王慧[1] 吴依娜[1] 翟振国[1] 甄雅南[1] 段军[1] Li Chen;Ma Junyu;Wang Shupeng;Wu Xiaojing;Zhai Shanshan;Chen Desheng;Wang Hui;Wu Yina;Zhai Zhenguo;Zhen Yanan;Duan Jun(Department of Surgical Intensive Care Unit,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院外科重症医学科,北京100029

出　　处：《中华胸心血管外科杂志》2021年第9期521-525,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨肺动脉内膜剥脱术(PEA)治疗肺血栓栓塞性肺动脉高压(CTEPH)的短期预后和术后呼吸系统并发症发生情况。方法收集2017年12月至2020年1月期间外科重症医学科连续收治的45例PEA治疗CTEPH术后患者临床病例资料,其中男20例,女25例;平均年龄51.2(25~70)岁,心功能(NYHA分级)Ⅲ~Ⅳ级24例(53.5%),术前肺血管阻力923(461~2711)dyn·s·cm^(-5)。按是否有呼吸系统并发症分为有呼吸系统并发症组和无呼吸系统并发症组,评估术后呼吸系统并发症发生的危险因素及其对短期预后的影响。结果全组无术中死亡,术后死亡2例(4.4%),死因分别为心源性休克和纵隔感染。术后发生呼吸系统并发症32例(71.1%),最常见为再灌注肺水肿20例(44.4%),其次为残余肺动脉高压5例(11.1%)。全组术后肺动脉平均压[术前37 mmHg,术后20 mmHg(1 mmHg=0.133 kPa)]和肺血管阻力(术前923 dyn·s·cm^(-5),术后293 dyn·s·cm^(-5))显著降低,差异均有统计学意义(P<0.05)。与无呼吸系统并发症组比较,有呼吸系统并发症组机械通气、ICU住院均较长,ICU费用较高,差异均有统计学意义(P<0.05)。从症状出现至PEA的时间间隔>36个月(OR=12.2,95%CI:2.1~70.7,P=0.005)和6 min步行距离<300 m(OR=12.6,95%CI:1.1~138.0,P=0.0038)是术后呼吸系统并发症的独立预测因子。结论PEA治疗CTEPH安全可行,术后呼吸系统并发症主要由症状出现时间和术前状态决定。CTEPH患者应尽早考虑PEA手术。Objective To investigate the short term outcomes and postoperative respiratory complications of patients with chronic thromboembolic pulmonary hypertension(CTEPH)treated by pulmonary endarterectomy(PEA).Methods 45 consecutive CTEPH patients underwent PEA between December 2017 and January 2020 in our institution were enrolled,including 25 females and 20 males.The mean age of operation was 51.2(25-70)years old.24(53.5%)patients were in New York Heart Association(NYHA)functional classⅢ-Ⅳ.The mean PVR before operation was 923(461-2711)dyn·s·cm^(-5).All patients’data were entered in a prospective database,divieded into patients with respiratory complications group(WRC)and without respiratory complications group(WORC).To assess risk factors for postoperative respiratory complications and its effect on short term outcomes.Results There was a significant reduction in mPAP(from 37 mmHg to 20 mmHg)and PVR(from 923 dyn·s·cm^(-5) to 293 dyn·s·cm^(-5))in the entire group.The in-hospital mortality rate was 4.4%(2 cases),died due to postoperative cardiogenic circulatory failure,even with VA-ECMO treatment and mediastinal infection,respectively.Postoperative respiratory complications occurred in 32 patients(71.1%).The most common complications were reperfusion pulmonary edema 44.4%(20 cases)and residual pulmonary hypertension 11.1%(5 cases).The WRC group showed a tendency to have longer periods of mechanical ventilation,longer ICU stays and more ICU costs.Independent predictors of postoperative respiratory complications were time from symptom onset to PEA>36 months(OR=12.2,95%CI:2.1-70.7,P=0.005)and six-minute walking distance<300 m(OR=12.6,95%CI:1.1-138.0,P=0.0038).Conclusion Pulmonary endarterectomy is an effective and safe treatment for CTEPH.Postoperative respiratory complications were mainly determined by symptom onset time and pre-operative status.Patients with CTEPH should consider PEA surgery early.

关 键 词：肺动脉内膜剥脱术 呼吸系统并发症 再灌注肺水肿 残余肺动脉高压 

分 类 号：R655.3[医药卫生—外科学]