中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

慢性血栓栓塞性肺动脉高压患者外科术后发生进展性肺动脉高压行序贯式球囊扩张治疗结果

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目的 探索慢性血栓栓塞性肺动脉高压患者行肺动脉内膜剥脱术后出现进展性肺动脉高压行后行分期序贯式球囊扩张治疗的技术要点。 方法 回顾性收集自 2014 年至 2017 年 7 例接受序贯式球囊扩张治疗的慢性血栓栓塞性肺动脉高压患者临床基本资料,包括临床基本信息如性别、年龄、既往病史及手术前后超声、右心导管结果,并进行 1 年以上定期随访,随访内容包括患者心功能结果,接受球囊扩张治疗时的球囊扩张次数及右心导管结果、超声结果等。其中男 1 例、女 6 例,年龄 58(43~59)。 结果 7 例患者接受肺动脉内膜剥脱手术术后出现肺动脉压力阻力进展性增高,随访期间予以序贯式肺动脉球囊扩张治疗,包括单次球囊扩张治疗 1 例,多次球囊扩张治疗 6 例。术后第 11(6~14)个月后首次接受球囊扩张治疗,球囊扩张次数为 2(2~6)次,单次球囊扩张治疗干预 3~5 个肺动脉段,与首次球囊扩张治疗前最近一次右心导管结果相比,肺动脉收缩压[从 53(47~75) 降低至 45(40~54)mm Hg,P=0.042],肺动脉平均压[从 38(29~47)下降至 29(25~39)mm Hg,P=0.043],氨基酸末端脑钠素前体[从 1 872(1 598~2 898)pg/ml 下降至 164(72~334)pg/ml,P=0.018)均明显改善,7 例患者均进行 12 个月以上随访(中位随访时间 14 个月),序贯式肺动脉球囊扩张治疗后心功能均改善为 WHO Ⅰ~Ⅱ级(P<0.05)。 结论 肺动脉内膜剥脱术后出现进展性肺动脉高压合并心功能改善不佳的患者行序贯球囊扩张治疗可进一步减轻该类患者右心后负荷,改善心功能。

Objective To describe the effect of sequential pulmonary balloon angioplasty for patients with chronic thromboembolic pulmonary hypertension, who was accompanied with progressed pulmonary hypertension after pulmonary endarterectomy surgeries. Methods From 2014 to December 2017, 7 patients were treated with a combination therapy of pulmonary endarterectomy and sequential pulmonary balloon angioplasty. There were 1 male and 6 females at age of 58 (43–59) years. A follow-up period of more than 1 year was accomplished. The result of right sided heart catheterization and ultrasonic cardiogram between and after the pulmonary endarterectomy or balloon angioplasty was collected. Results 7 patients were treated with a combination of pulmonary endarterectomy and sequential pulmonary balloon angioplasty, which include 1 patient of single pulmonary balloon angioplasty and 6 patients of multiple pulmonary balloon angioplasties. The balloon dilation times was 2 (2–6), and the number of segments during each single balloon dilatation was 3–5, compared with the first clinical results before the first balloon dilation, the systolic pulmonary artery pressure [53 (47–75) mm Hg vs. 45 (40–54) mm Hg, P=0.042), mean pulmonary artery pressure [38 (29–47) mm Hg vs. 29 (25–39) mm Hg, P=0.043], N terminal-B type natriuretic peptide [1 872 (1 598–2 898) pg/ml vs. 164 (72–334) pg/ml, P=0.018] were improved significantly after the last balloon angioplasty. all the 7 patients were recovered to NYHA I-II classes (P<0.05). Conclusion Sequential pulmonary balloon angioplasty after pulmonary endarterectomy can further reduce the patient's right heart after load, improve the heart function for patients with progressed pulmonary hypertension after pulmonary endarterectomy surgeries.

关键词: 慢性血栓栓塞性肺动脉高压; 肺动脉内膜剥脱术; 序贯式肺动脉球囊扩张术; 治疗结果

Key words: Chronic thromboembolic pulmonary hypertension; pulmonary endarterectomy; sequential pulmonary balloon angioplasty; treatment result

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