慢性血栓栓塞性肺动脉高压患者行肺动脉内膜剥脱术后运动能力的长期恢复情况。
Long-term recovery of exercise ability after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension.
作者信息
Matsuda Hitoshi, Ogino Hitoshi, Minatoya Kenji, Sasaki Hiroaki, Nakanishi Norifumi, Kyotani Shingo, Kobayashi Junjiro, Yagihara Toshikatsu, Kitamura Soichiro
机构信息
Department of Cardio-Vascular Surgery, National Cardio-Vascular Center, Suita, Osaka, Japan.
出版信息
Ann Thorac Surg. 2006 Oct;82(4):1338-43; discussion 1343. doi: 10.1016/j.athoracsur.2006.03.105.
BACKGROUND
The exercise capacity of patients with thromboembolic pulmonary hypertension was investigated to clarify the long-term effects of pulmonary endarterectomy. This capacity was assessed by measuring cardiopulmonary factors during cardiopulmonary exercise testing at the maximal level of exercise and a 6-minute walk test at the submaximal level. Their survival rate was also determined.
METHODS
We conducted a retrospective review of the clinical records of 102 patients who underwent pulmonary endarterectomy (63 women; median age, 53 years).
RESULTS
Eight (7.8%) hospital mortalities were encountered. Three late mortalities due to fulminant hepatitis, breast cancer, and pneumonia in a patient under steroid therapy were unrelated to pulmonary endarterectomy. The actual survival rate including hospital mortalities was 90.9% at 3 years and 84.0% at 5 years. All hemodynamic measurements significantly improved and reached a plateau 1-month after endarterectomy. The cardiopulmonary exercise test at the maximal exercise level revealed that peak oxygen uptake (V(O2)) baseline was 13.8 +/- 3.2 mL/min/kg, and at 1-month was 16.2 +/- 4.2 mL/min/kg (p = 0.0015) and ventilatory response to carbon dioxide production (V(E)-V(CO2)) slope baseline was 46.5 +/- 8.4 mL/min/kg, and at 1-month was 39.9 +/- 7.4 (p = 0.0006), which gradually and significantly improved during the first year after endarterectomy (peak V(O2), 19.9 +/- 3.9 mL/min/kg [p < 0.0001] and V(E)-V(CO2) slope, 33.2 +/- 5.4 mL/min/kg [p <0.0001]). The 6-minute walk test, which reflects the systemic response at the submaximal level of functional capacity, showed that the walking distance gradually and significantly increased for up to 1 year after endarterectomy (baseline, 358 +/- 102 meters [m]; at 1-month, 433 +/- 105 m; and at 1-year, 490 +/- 80 m [p < 0.0001]) and then reached a plateau.
CONCLUSIONS
After pulmonary endarterectomy, the hemodynamic recovery occurred immediately, and the patients' exercise capacity improved during the year. The 6-minute walk test was a good indicator to assess the recovery of exercise capacity.
背景
对血栓栓塞性肺动脉高压患者的运动能力进行研究，以阐明肺动脉内膜剥脱术的长期效果。通过在最大运动水平的心肺运动测试和次最大运动水平的6分钟步行测试中测量心肺因素来评估这种能力。还确定了他们的生存率。
方法
我们对102例行肺动脉内膜剥脱术的患者（63例女性；中位年龄53岁）的临床记录进行了回顾性分析。
结果
发生8例（7.8%）医院死亡病例。3例晚期死亡分别因暴发性肝炎、乳腺癌以及1例接受类固醇治疗患者的肺炎，与肺动脉内膜剥脱术无关。包括医院死亡病例在内的实际生存率在3年时为90.9%，5年时为84.0%。所有血流动力学测量值均显著改善，并在内膜剥脱术后1个月达到平台期。最大运动水平的心肺运动测试显示，峰值摄氧量（V（O2））基线为13.8±3.2 mL/min/kg，1个月时为16.2±4.2 mL/min/kg（p = 0.0015），对二氧化碳产生的通气反应（V（E）-V（CO2））斜率基线为46.5±8.4 mL/min/kg，1个月时为39.9±7.4（p = 0.0006），在内膜剥脱术后第一年逐渐且显著改善（峰值V（O2），19.9±3.9 mL/min/kg [p < 0.0001]，V（E）-V（CO2）斜率，33.2±5.4 mL/min/kg [p <0.0001]）。反映次最大功能能力水平全身反应的6分钟步行测试显示，步行距离在内膜剥脱术后长达1年逐渐且显著增加（基线，358±102米[m]；1个月时，433±105 m；1年时，490±80 m [p < 0.0001]），然后达到平台期。
结论
肺动脉内膜剥脱术后，血流动力学立即恢复，患者运动能力在1年内得到改善。6分钟步行测试是评估运动能力恢复的良好指标。
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