慢性血栓栓塞性肺动脉高压手术治疗效果分析的单中心经验  

Analysis of the surgical treatment effects of chronic thromboembolic pulmonary hypertension:a single-center experience

作　　者：刘晓鹏 甄雅南[1] Liu Xiaopeng;Zhen Ya'nan(Department of Cardiovascular Surgery,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院心脏血管外科,北京100029

出　　处：《中华血管外科杂志》2025年第1期44-49,共6页Chinese Journal of Vascular Surgery

基　　金：中央高水平医院临床科研业务费(2023-NHLHCRF-PY-10);中日友好医院“菁英计划”人才培育工程(ZRJY2023-GG10)。

摘　　要：目的总结分析肺动脉内膜切除术(PEA)治疗慢性血栓栓塞性肺动脉高压(CTEPH)的初步疗效。方法本研究为回顾性纵向研究。收集2016年12月至2023年12月中日友好医院心脏血管外科行PEA手术治疗的142例CTEPH患者的临床资料。其中男性96例(67.6%),女性46例(32.4%);年龄(50.0±13.8)岁。81例患者为重度肺动脉高压且心功能Ⅲ级(纽约分级)及以上。术后随访3个月,观察CTEPH患者的一般情况,PEA手术结果及术后并发症情况等。采用配对t检验比较手术前后平均肺动脉压(mPAP)、肺血管阻力(PVR)及6 min步行距离指标,采用χ^(2)检验比较手术前后心功能分级变化情况。结果 142例患者均成功完成PEA手术,技术成功率为100%。PEA围手术期死亡率为5.6%(8/142),包括重度感染3例,术后反复肺动脉出血2例,急性心功能衰竭2例,多脏器功能衰竭1例。患者术后24 h[mPAP:(22.5±8.7)mmHg比(42.7±15.1)mmHg,t=19.82;PVR:(425.6±211.2)dyn·s·cm^(-5) 比(927.9±455.9)dyn·s·cm^(-5),t=12.79]和术后3个月[mPAP:(20.1±10.2)mmHg 比(42.7±15.1)mmHg,t=20.92;PVR:(300.6±133.6)dyn·s·cm^(-5) 比(927.9±455.9)dyn·s·cm^(-5),t=16.41]的mPAP 和PVR水平均较术前降低,差异均有统计学意义(均P<0.001)。142例患者均完成3个月随访。术后3个月95.5%(128/134)的患者心功能分级为Ⅰ~Ⅱ级,较术前改善,差异具有统计学意义(χ^(2)=26.52,P<0.001)。术后3个月6 min步行距离较术前增加,差异有统计学意义[(495.2±99.7)m比(283.9±110.3)m,t=6.72,P<0.001]。2例患者有器质性神经系统损伤,治疗后均康复。22例患者接受PEA的同期还接受了其他手术,均顺利出院。结论 PEA手术治疗CTEPH安全有效,且初步疗效较满意。ObjectiveTo summarize the initial effects of the pulmonary endarterectomy(PEA)for treating chronic thromboembolic pulmonary hypertension(CTEPH).MethodsIn this retrospective longitudinal study,clinical data from 142 cases undergoing PEA between December 2016 and December 2023 at the Department of Cardiovascular Surgery,China-Japan Friendship Hospital were collected,including 96 males(67.6%)and 46 females(32.4%),with a mean age of(50.0±13.8)years.Eighty-one patients were with severe pulmonary hypertension at ClassⅢorⅣ(according to NYHA Functional Classification).The follow-up was conducted 3 months after surgery,during which the general condition of the cases,the results of PEA,and complications were observed and recorded.The paired t-test was adopted for the comparison of mPAP,PVR,and indicators in the six-minute walk test before and after the surgery.The chi-square test was utilized to compare the functional classification of the heart before and after the surgery.ResultsAll 142(100%)cases underwent successful PEA.The perioperative mortality rate was 5.6%(8 in 142),including 3 cases of severe infection,2 cases of recurrent pulmonary artery hemorrhage after surgery,2 cases of acute heart failure,and 1 case of multiple organ dysfunction syndrome.In contrast to the condition before PEA,the mPAP and PVR decreased 24 hours after the surgery[mPAP:(22.5±8.7)mmHg vs(42.7±15.1)mmHg,t=19.82;PVR:(425.6±211.2)dyn·s·cm^(-5) vs(927.9±455.9)dyn·s·cm^(-5),t=12.79]and 3 months after the surgery[mPAP:(20.1±10.2)mmHg vs(42.7±15.1)mmHg,t=20.92;PVR:(300.6±133.6)dyn·s·cm^(-5) vs(927.9±455.9)dyn·s·cm^(-5),t=16.41],all were with statistically significant differences(all P<0.001).All 142 patients were folloued up for 3 months.According to the statistics during the three-month follow-up,95.5%(128 in 134)of cases were ranked ClassⅠ-Ⅱ,indicating the improvement in heart function after PEA with statistically significant differences(χ^(2)=26.52,P<0.001).The walking distance in the six-minute walk test increased 3 mon

关 键 词：慢性血栓栓塞性肺动脉高压 肺动脉内膜剥脱术 手术效果 并发症 

分 类 号：R54[医药卫生—心血管疾病]