球囊肺动脉成形术治疗肺动脉血栓内膜剥脱术后残余/复发肺动脉高压的疗效和安全性研究  

Efficacy and safety of balloon pulmonary angioplasty for postoperative residual/recurrent pulmonary hypertension of pulmonary thromboendarterectomy

作　　者：孙帅 汪薇 龚娟妮[1] 丁媛 杨媛华[1] Sun Shuai;Wang Wei;Gong Juanni;Ding Yuan;Yang Yuanhua(Department of Respiratory and Critical Care Medicine,Beijing Chaoyang Hospital,Capital Medical University,Beijing Institute of Respiratory Diseases,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院呼吸与危重症医学科北京呼吸疾病研究所,北京100020

出　　处：《国际呼吸杂志》2022年第5期369-374,共6页International Journal of Respiration

基　　金：国家自然科学基金(31670928)。

摘　　要：目的对球囊肺动脉成形术(BPA)治疗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(PEA)术后残余/复发肺动脉高压的有效性和安全性进行评估。方法本研究为单中心病例对照研究。采用非随机抽样的方法纳入2004年11月至2021年12月于首都医科大学附属北京朝阳医院行PEA的CTEPH患者76例,其中发生PEA术后残余/复发肺动脉高压的患者17例,9例采用BPA治疗。收集患者基线资料、PEA及BPA前后平均肺动脉压(mPAP)、肺血管阻力(PVR),超声心动图、WHO功能分级、N末端脑钠肽前体等数据,并在末次BPA后进行至少6个月的随访。采用SPSS 26.0对数据进行统计分析。结果PEA术后残余/复发性肺动脉高压发生率为22.4%(17/76)。9例残余/复发肺动脉高压患者在PEA术后进行了BPA治疗,其中男6例,女3例;年龄(52.6±10.8)岁,年龄范围为36~71岁。PEA术后与BPA治疗前的间隔时间为(54.9±64.5)个月,进行BPA次数为(2.7±1.1)次。末次BPA后与首次BPA治疗前相比,mPAP从(41.1±9.1)mmHg降低至(35.0±5.6)mmHg(t=3.21,P=0.012),PVR从(601.3±289.4)dyn·s/cm^(5)降低至(414.5±284.1)dyn·s/cm^(5)(t=1.10,P=0.386)。BPA前后右心室结构和功能差异均无统计学意义(P值均>0.05)。BPA治疗前WHO功能分级Ⅰ/Ⅱ级患者7例,Ⅲ/Ⅳ级患者2例,治疗后均达到Ⅰ/Ⅱ级(Z=1.41,P=0.157)。在BPA治疗过程中,1例出现咯血,经内科治疗后改善。1例患者在BPA术后4个月后死于脑出血。结论BPA可进一步降低CTEPH患者PEA术后的肺动脉高压及改善右心功能,不良反应发生率低。Objective To evaluate the efficacy and safety of balloon pulmonary angioplasty(BPA)for postoperative residual/recurrent pulmonary hypertension of pulmonary thromboendarterectomy(PEA)in patients with chronic thromboembolic pulmonary hypertension(CTEPH).Methods This is a single-center case-control study.A non-random sampling leaded totally 76 CTEPH patients underwent PEA form Beijing Chaoyang Hospital Affiliated to Capital Medical University(November 2004 to December 2021)to enroll;of which,PEA-postoperative residual/recurrent pulmonary hypertension in 17 patients were reported,and BPA were performed in 9 cases.The key observation was baseline data of patients,mean pulmonary arterial pressure(mPAP),pulmonary vascular resistance(PVR),echocardiography,WHO functional class,N-terminal fragment pro-brain natriuretic peptide(NT-proBNP)before and after PEA and BPA.At the end of the last BPA,more than 6-month follow-up was performed,and statistical analysis of the data was performed using SPSS 26.0.Results The incidence of postoperative residual/recurrent pulmonary hypertension was 22.4%(17/76),and in 9 underwent BPA patients with PEA-postoperative residual/recurrent pulmonary hypertension included 6 male and 3 female,age(52.6±10.8)years,age range(36-71)years.The interval length between PEA-postoperative and BPA-preoperative was(54.9±64.5)months,BPA frequency was(2.7±1.1).The last treatment vs the first treatment of BPA,mPAP decreased from(41.1±9.1)mmHg to(35.0±5.6)mmHg(t=3.21,P=0.012),and PVR decreased from(601.3±289.4)dyn·s/cm^(5) to(414.5±284.1)dyn·s/cm^(5)(t=1.10,P=0.386).There were no statistically significant differences of right ventricular structure and function in pre-and post-BPA(all P>0.05).Before BPA,there were 7 patients with WHO functional classⅠ/Ⅱand 2 patients with classⅢ/Ⅳ,they all achieved classⅠ/Ⅱafter treatment(Z=1.41,P=0.157).During BPA treatment,1 case developed hemoptysis and had improved after medical treatment.One patient succumbed to cerebral hemorrhage month 4 BPA-postoperati

关 键 词：肺动脉高压 血栓栓塞 效率 有效性 安全性 肺动脉血栓内膜剥脱术 球囊肺动脉成形术 

分 类 号：R544.1[医药卫生—心血管疾病]