Archibald C J, Auger W R, Fedullo P F, Channick R N, Kerr K M, Jamieson S W, Kapelanski D P, Watt C N, Moser K M
Division of Pulmonary and Critical Care Medicine and Division of Cardiothoracic Surgery, University of California, San Diego, San Diego, California, USA.
Am J Respir Crit Care Med. 1999 Aug;160(2):523-8. doi: 10.1164/ajrccm.160.2.9808109.
This study evaluated long-term outcome of pulmonary thromboendarterectomy (PTE) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Survival, functional status, quality of life, health care utilization, and relationships between these parameters and postoperative pulmonary hemodynamics were assessed. Questionnaires were mailed to 420 patients who were more than 1 yr post-PTE; 308 responded (mean age, 56 yr [range, 19-89 yr]; mean years since PTE, 3.3 [range, 1- 16]). Survival after PTE was 75% at > 6 yr. After surgery, symptoms were markedly reduced. Median distance walked was 5,280 ft; 56 patients could walk "indefinitely." Of the working population, 62% of patients unemployed before PTE returned to work. Post-PTE patients scored several quality of life components of the Rand SF-36 slightly lower than reported normals but significantly higher than did pre-PTE patients. Ten percent of patients used oxygen. Ninety-three percent were in NYHA Class I or II. Disease-related hospitalizations/ER visits were minimal. A relationship was shown between 48 h postoperative pulmonary vascular resistance (PVR) and walking and stair-climbing ability, NYHA class, dyspnea scores, and the physical function and general health quality of life components. These data indicate that PTE offers most CTEPH patients substantial improvement in survival, function, and quality of life, with minimal disease-related health care utilization.
本研究评估了慢性血栓栓塞性肺动脉高压（CTEPH）患者行肺动脉血栓内膜剥脱术（PTE）的长期预后。评估了生存率、功能状态、生活质量、医疗保健利用情况，以及这些参数与术后肺血流动力学之间的关系。向420例PTE术后1年以上的患者邮寄了调查问卷；308例患者进行了回复（平均年龄56岁[范围19 - 89岁]；PTE术后平均年限3.3年[范围1 - 16年]）。PTE术后6年以上的生存率为75%。术后症状明显减轻。步行的中位数距离为5280英尺；56例患者能够“不限距离”行走。在有工作的人群中，PTE术前失业的患者中有62%恢复了工作。PTE术后患者在兰德36项健康调查简表（Rand SF - 36）的几个生活质量方面的得分略低于报告的正常水平，但显著高于PTE术前患者。10%的患者使用氧气。93%的患者心功能分级为纽约心脏协会（NYHA）I级或II级。与疾病相关的住院/急诊就诊次数很少。术后48小时的肺血管阻力（PVR）与步行和爬楼梯能力、NYHA分级、呼吸困难评分以及生活质量的身体功能和总体健康方面之间存在关联。这些数据表明，PTE能使大多数CTEPH患者的生存率、功能和生活质量得到显著改善，且与疾病相关的医疗保健利用最少。
