经皮肺动脉球囊成形术治疗慢性血栓栓塞性肺动脉高压操作规程专家共识  

Consensus on the procedure of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension

作　　者：中国医师协会呼吸医师分会肺栓塞与肺血管病工作组 中华医学会呼吸病学分会肺栓塞与肺血管病学组 全国肺动脉高压标准化体系建设项目专家组 国家呼吸医学中心肺栓塞与肺血管病专家委员会 洪城[2] 黄强 熊长明 翟振国[3] Group of Pulmonary Embolism and Pulmonary Vascular Disease,Chinese Association of Chest Physicians;Working Committee of Pulmonary Embolism and Pulmonary Vascular Disease,Chinese Thoracic Society,Expert Committee;National Project of Standardized Diagnosis and Treatment of Pulmonary Hypertension;Expert Committee of Pulmonary Embolism and Pulmonary Vascular Disease,National Center for Respiratory Medicine;Hong Cheng;Huang Qiang;Xiong Changming;Zhai Zhenguo(不详;Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510000,China;Department of Pulmonary and Critical Care Medicine,Center of Respiratory Medicine,China-Japan Friendship Hospital,Beijing 100029,China;Center of Respiratory and Pulmonary Vascular Diseases,Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]不详 [2]广州医科大学附属第一医院呼吸与危重症医学科,广州510000 [3]中日友好医院呼吸中心呼吸与危重症医学科,北京100029 [4]中国医学科学院阜外医院呼吸与肺血管病诊治中心,北京100037

出　　处：《中华结核和呼吸杂志》2024年第5期404-418,共15页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：国家重点研发计划(2023YFC2507200);中央高水平医院临床科研业务费资助(2022-NHLHCRF-LX-01-0203);国家自然科学基金(82241029,82370062);中国医学科学院医学与健康科技创新工程(2021-I2M-1-049);广州地区临床重大项目(2023C-ZD-05)。

摘　　要：慢性血栓栓塞性肺动脉高压(chronic thromboembolic pulmonary hypertension,CTEPH)是以肺动脉血栓机化致血管狭窄或闭塞,肺血管阻力和肺动脉压力进行性升高,最终导致右心功能衰竭为特征的一类疾病,属于肺动脉高压的第4大类。不同于其他类型肺动脉高压,CTEPH可以通过外科手术、血管介入和(或)靶向药物治疗显著改善预后。肺动脉内膜剥脱术(pulmonary endarterectomy,PEA)是CTEPH的首选治疗方法。但其创伤较大、手术风险较高,目前国内仅有少数中心开展。经皮肺动脉球囊成形术(balloon pulmonary angioplasty,BPA)是近年迅速发展的肺动脉介入治疗技术,可作为不适合PEA或PEA术后残余肺动脉高压患者的治疗选择。目前BPA在我国兴起,但由于其操作较复杂,且对术者技术水平和医院设备有一定要求,国内尚缺乏统一的BPA操作规程和技术指导,从而限制国内BPA技术的进一步提升与发展。基于此,为进一步规范和推广BPA技术,经过多学科专家研讨和德尔菲专家论证,工作组牵头制定了《经皮肺动脉球囊成形术治疗慢性血栓栓塞性肺动脉高压操作规程专家共识》,针对BPA操作准入标准、围手术期管理、手术规划、技术方法、并发症防治等诸多方面进行了阐述,以期为BPA治疗CTEPH提供推荐意见和临床指导,规范BPA在CTEPH治疗中的临床应用。Chronic thromboembolic pulmonary hypertension(CTEPH)is classified as group IV pulmonary hypertension,characterized by thrombotic occlusion of the pulmonary arteries leading to vascular stenosis or obstruction,progressive increase in pulmonary vascular resistance and pulmonary arterial pressure,and eventual right heart failure.Unlike other types of pulmonary hypertension,the prognosis of CTEPH can be significantly improved by surgery,vascular intervention,and/or targeted drug therapy.Pulmonary endarterectomy(PEA)is the preferred treatment of choice for CTEPH.However,PEA is an invasive procedure with high operative risks,and is currently only performed in a few centers in China.Balloon pulmonary angioplasty(BPA)is an emerging interventional technique for CTEPH,serving as an alternative for patients who are ineligible for PEA or with residual pulmonary hypertension after PEA.BPA is gaining traction in China,but its widespread adoption is limited due to its complexity,operator skills,and equipment requirements,a lack of standard operating procedures and technical guidance,which limit the further improvement and development of BPA in China.To address this,a multidisciplinary panel of experts was convened to develop the Consensus on the Procedure of Balloon Pulmonary Angioplasty for the Chronic Thromboembolic Pulmonary Hypertension,which fomulates guidelines on BPA procedural qualification,perioperative management,procedural planning,technical approach,and complication prevention,with the aim of providing recommendations and clinical guidance for BPA treatment in CTEPH and standardizing its clinical application in this setting.

关 键 词：球囊成形术 肺血管阻力 围手术期管理 血管介入 血栓机化 并发症防治 肺动脉高压 医院设备 

分 类 号：R544.1[医药卫生—心血管疾病]