不同类型的慢性血栓栓塞性肺动脉高压肺血管病变的介入治疗策略  

Interventional Treatment Strategy for Different Types of Pulmonary Artery Lesions in Chronic Thromboembolic Pulmonary Hypertension

作　　者：李欣 杨涛 张毅 罗勤[1] 赵青 曾绮娴 章思铖 赵智慧 柳志红 LI Xin;YANG Tao;ZHANG Yi;LUO Qin;ZHAO Qing;ZENG Qixian;ZHANG Sicheng;ZHAO Zhihui;LIU Zhihong(Pulmonary Vascular Disease Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Intensive Care Unit,Sichuan Provincial People's Hospital,University of Electronic Science and Technology of China,Chengdu 610072,China)

机构地区：[1]中国医学科学院、北京协和医学院、国家心血管病中心、阜外医院呼吸与肺血管疾病诊治中心,北京100037 [2]电子科技大学四川省人民医院重症医学中心,成都610072

出　　处：《中国循环杂志》2025年第2期190-196,共7页Chinese Circulation Journal

基　　金：国家重点研发计划(2023YFC2507203);中央高水平医院临床科研专项(2022-GSP-GG-35);中国医学科学院医学与健康科技创新工程项目(2023-I2M-C&T-B-063);四川省人民医院青年科学基金(2023QN02)。

摘　　要：慢性血栓栓塞性肺动脉高压(CTEPH)是一类慢性进展性疾病,其特征是机化的血栓阻塞肺动脉,伴随非阻塞部位的小血管病变,可导致右心衰竭和死亡。肺动脉内膜剥脱术(PEA)是CTEPH患者的根治性手术,但约40%的患者不能接受PEA或术后残留肺动脉高压。对于这些患者,球囊肺动脉成形术(BPA)是有效的治疗方法,可显著改善患者的血液动力学、运动耐力和预后。随着BPA证据的积累,2022年欧洲心脏病学会/欧洲呼吸学会发布的肺动脉高压指南推荐将其作为不适合PEA或术后残留肺动脉高压患者的替代治疗。但不同类型CTEPH病变的特征存在差异,相应的BPA治疗策略和器械有所不同,BPA治疗成功率和并发症发生率差异也较大。本文旨在总结当前不同类型CTEPH病变的BPA治疗策略及相关并发症处理方法,为临床医师提供指导。Chronic thromboembolic pulmonary hypertension is characterised by the persistent obstruction of the proximal pulmonary arteries by organized thrombi and peripheral microvascular disease,which can lead to right-sided heart failure and mortality.Pulmonary endarterectomy enables complete removal of visible obstructive elements within the pulmonary arteries and is recommended for operable patients.Nevertheless,over 40%of patients are precluded from pulmonary endarterectomy because of factors such as surgically inaccessible lesions,compromised general health status,or concurrent comorbidities or still with residual pulmonary hypertension after pulmonary endarterectomy.For inoperable patients or those with residual pulmonary hypertension after pulmonary endarterectomy,balloon pulmonary angioplasty is an effective therapeutic option,which could significantly improve the hemodynamic,exercise tolerance and outcome of the patients.With the emerging accumulation of clinical experience and evidence,2022 European Society of Cardiology/European Respiratory Society guidelines of pulmonary hypertension recommend balloon pulmonary angioplasty as an alternative therapeutic option for these patients.However,different types of lesions may have their own lesion characteristics,the strategy and device of balloon pulmonary angioplasty should thus be individually considered for different lesions,in fact,the success rate of treatment and the incidence rate of complications are varied significantly.Therefore,the aim of this review is to comprehensively summarize the existing studies on balloon pulmonary angioplasty treatment strategies for different types of lesions and the management of complications to provide guidance and reference for clinicians.

关 键 词：肺动脉高压 介入治疗 慢性血栓栓塞性肺动脉高压 球囊肺动脉成形术 策略 

分 类 号：R54[医药卫生—心血管疾病]