慢性血栓栓塞性肺动脉高压患者行球囊扩张成形术疗效分析

刘志煜; 曹昶; 陈熙; 徐若琛; 郑颖颖; 上官佳红; 唐俊楠; 张金盈

doi:10.16766/j.cnki.issn.1674-4152.003190

慢性血栓栓塞性肺动脉高压患者行球囊扩张成形术疗效分析

doi: 10.16766/j.cnki.issn.1674-4152.003190

刘志煜^{1, 2, 3},
曹昶^{1, 2, 3},
陈熙^{1, 2, 3},
徐若琛⁴,
郑颖颖^{1, 2, 3},
上官佳红^{1, 2, 3},
唐俊楠^{1, 2, 3},
张金盈^{1, 2, 3, ,}

1.
郑州大学第一附属医院心血管内科，河南郑州 450052
2.
河南省心脏损伤修复重点实验室，河南郑州 450052
3.
河南省心血管疾病临床医学研究中心，河南郑州 450052
4.
郑州大学基础医学院医学遗传与细胞生物学系，河南郑州 450001

基金项目:

国家自然科学基金项目 82000238

国家自然科学基金项目 81870328

河南省优秀青年科学基金项目 202300410362

详细信息

通讯作者:
张金盈，E-mail: jyzhang@zzu.edu.cn

中图分类号: R544.16
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- 文章访问数: 240
- HTML全文浏览量: 77
- PDF下载量: 29
- 被引次数: 0
出版历程
- 收稿日期: 2022-10-20
- 网络出版日期: 2023-11-23

Analysis of the treatment effect of percutaneous balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension

LIU Zhiyu^{1, 2, 3},
CAO Chang^{1, 2, 3},
CHEN Xi^{1, 2, 3},
XU Ruochen⁴,
ZHENG Yingying^{1, 2, 3},
SHANGGUAN Jiahong^{1, 2, 3},
TANG Junnan^{1, 2, 3},
ZHANG Jinying^{1, 2, 3
, ,}

1.
Department of Cardiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China

摘要

摘要: 目的评价球囊扩张成形术(BPA)治疗慢性血栓栓塞性肺动脉高压(CTEPH)的有效性和安全性。方法选择2019年10月—2022年6月郑州大学第一附属医院确诊CTEPH接受BPA手术的8例住院患者，收集患者的基本临床特征，观察BPA手术前后血流动力学指标、心脏结构改善情况及手术并发症事件的发生情况。结果女性患者5人，男性患者3人。发病时年龄为(55.25±10.45)岁，由急性肺栓塞进展至CTEPH形成时间为(10.87±6.10)个月，随访时长为(255.50±149.71)d，共进行BPA手术46次，出现咯血并发症1次发生于大动脉炎患者，平均BPA次数为(5.75±3.57)次。BPA术后肺动脉平均压由(92.25±33.59)mmHg(1 mmHg=0.133 kPa)降至(53.87±27.58)mmHg(P=0.022)；氨基末端脑钠肽前体、心输出量、心指数、三尖瓣反流速度、左心室舒张末期容积、纽约心脏病学会心功能分级均明显改善(均P < 0.05)。比较患者BPA手术前、出院前及随访时的心脏结构指标发现，右心室直径、左心室直径和右心房上下径均有改善(均P < 0.05)。结论 BPA手术作为一种新型手术方案，在CTEPH患者中应用后可改善血流动力学指标和心脏结构，同时并发症较少。
- 慢性血栓栓塞性肺动脉高压 /
- 球囊扩张成形术 /
- 急性肺栓塞
Abstract: Objective To evaluate the efficacy and safety of balloon pulmonary angioplasty (BPA) in a cohort of patients with pulmonary hypertension due to chronic thrombotic and/or embolic disease (CTEPH). Methods From October 2019 to June 2022, 8 patients diagnosed with CTEPH at the First Affiliated Hospital of Zhengzhou University underwent BPA surgery. The basic clinical characteristics of the patients were collected, and the hemodynamic indexes, improvement of cardiac structure, and surgical complications were observed. Results There were 5 female and 3 male patients. The mean age at presentation was (55.25±10.45) years, and the mean progressed period of CTEPH was (10.87±6.10) months, and the average follow-up duration was (255.50±149.71) days. A total of 46 BPA operations were performed, with one hemoptysis complication occurred in a patient with Takayasu' s arteritis, and the average number of BPA operations was (5.75±3.57) times. Mean pulmonary artery pressure after BPA decreased from (92.25±33.59) mmHg (1 mmHg=0.133 kPa) to (53.87±27.58) mmHg (P=0.022). NT-proBNP, cardiac output, cardiac index, tricuspid regurgitation velocity, EDV and NYHA were significantly improved (all P < 0.05). When cardiac structural parameters were compared before BPA surgery, before discharge and at follow-up, right ventricular diameter, left ventricular diameter, and right atrial upper and lower diameter were all improved (all P < 0.05). Conclusion BPA is a new surgical technique that can improve hemodynamic indexes and cardiac structure in CTEPH patients with fewer complications.
- Pulmonary hypertension due to chronic thrombotic and/or embolic disease /
- Balloon pulmonary angioplasty /
- Acute pulmonary embolism

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图 1 CTEPH患者BPA手术前后肺动脉造影对比

注：A为动脉造影提示右肺中动脉分支开口血流闭塞；B为球囊至病变处扩张；C为造影提示狭窄明显减轻，前向血流3级。

Figure 1. Comparison of pulmonary angiography in CTEPH patients before and after BPA Surgery

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表 1 8例CTEPH患者行BPA前一般临床资料

Table 1. General clinical characteristics of 8 patients with CTEPH prior to BPA

编号	年龄(岁)	性别	CTEPH进展时程(月)	合并症	PAH药物治疗方案	BPA次数	择期手术次数	随访时长(d)
1	52	女性	10	中度三尖瓣关闭不全	安立生坦，西地那非	3	1	217
2	40	女性	5	左下肢静脉血栓	安立生坦，利奥西呱	2	1	198
3	62	男性	12	3级高血压，肺气肿	安立生坦，利奥西呱	8	3	271
4	66	男性	11	重度三尖瓣关闭不全，冠心病	贝前列素那，安立生坦，西地那非	7	2	31
5	68	女性	12	冠心病支架术后，3级高血压，糖尿病	安立生坦，利奥西呱	9	3	207
6	44	女性	24	大动脉炎，右肾动脉狭窄支架术后，甲状腺功能亢进症	西地那非	5	3	301
7	61	男性	9	心房颤动，下肢静脉曲张	利奥西呱	11	4	252
8	49	女性	4	下肢静脉血栓，中度三尖瓣关闭不全	未使用PAH药物治疗方案	1	1	566
注：编号6患者出现一次手术失败情况。

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表 2 8例CTEPH患者BPA手术前和出院前血流动力学指标比较

Table 2. Comparison of hemodynamic parameters before and at discharge in 8 patients with CTEPH undergoing BPA

项目	手术前	出院前	统计量	P值
肺动脉平均压(x±s, mmHg)	92.25±33.59	53.87±27.58	3.620^a	0.022
NT-proBNP[M(P₂₅, P₇₅), pg/mL]	5 300.72(1 136.15，5 685.00)	377.29(74.98，946.00)	-2.201^b	0.028
心输出量(x±s, L/min)	4.60±1.71	5.88±1.99	-2.923^a	0.027
心指数[x±s, L/(min·m²)]	2.79±1.13	3.51±1.23	-3.013^a	0.024
肺动脉环径(x±s, mm)	24.28±3.09	23.57±3.20	0.420^a	0.689
三尖瓣反流速度(x±s, m/s)	4.41±0.93	3.22±0.93	4.095^a	0.005
EDV(x±s, mL)	66.57±26.96	89.71±24.28	-3.065^a	0.022
ESV(x±s, mL)	22.78±8.94	30.35±10.57	-2.177^a	0.072
LVEF(x±s, %)	64.37±4.47	66.00±5.63	-0.604^a	0.565
NYHA心功能分级(Ⅲ级/Ⅳ级，例)	0/8	6/2	5.143^c	0.016
注：^a为t值，^b为Z值，^c为χ²值。

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表 3 8例CTEPH患者BPA手术前、出院前和随访时心脏结构测量结果比较(x±s，mm)

Table 3. Comparison of cardiac structural measurements before, at discharge, and during follow-up in 8 patients with CTEPH undergoing BPA (x±s, mm)

项目	手术前	出院前	随访时	F值	P值
右心室直径	26.42±7.43	20.75±4.83	18.57±6.39	5.982	0.016
左心室直径	38.57±4.99	43.37±4.62	42.00±4.72	8.013	0.028
右心房左右径	46.14±9.70	38.12±7.56	37.14±6.64	1.914	0.241
右心房上下径	57.71±8.97	49.12±8.77	47.00±10.47	6.191	0.014

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参考文献(20)

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