[通过肺动脉血栓内膜剥脱术治疗慢性血栓栓塞性肺动脉高压及其深低温停循环对其的影响]

Gan Hui-Li, Zhang Jian-Qun, Chen Hui, Mu Jun-Sheng, Zhou Qi-Wen, Wang Sheng-Xun, Zheng Si-Hong, Zhang Xiang-Feng, Liu Shuang

Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.

Zhonghua Yi Xue Za Zhi. 2007 Jun 5;87(21):1482-5.

OBJECTIVE

To evaluate the role of the pulmonary thromboendarterectomy (PTE) in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) and the effect of the deep hypothermia circulation arrest (DHCA) thereon.

METHODS

The clinical data of 40 cases of CTEPH, 25 cases of central type and 15 cases of peripheral type, 29 males and 11 females, aged 46 +/- 12 (20 - 70), underwent PTH, 17 under deep hypothermia circulatory arrest (DHCA, Group A) and 23 not under DHCA (Group B), from February 1995 to October 2006. Follow-up was conducted for 41.8 +/- 36.4 months.

RESULTS

In the peri-operative period, no patient died in Group A and there were 6 deaths in Group B. 9 suffered with residual pulmonary hypertension and 18 with severe pulmonary reflux injury. 72 h after the PTE, the pulmonary artery systolic pressure (PASP) was 58.3 +/- 30.7 mm Hg, significantly lower than that before PTS (91.4 +/- 38.4 mm Hg, P < 0.05), the pulmonary vascular resistance (PVR) was 357 +/- 278.7 dynes x sec(-1) x cm(-5), significantly lower than that before PTE (978 +/- 675.6 dynes x sec(-1) x cm(-5), P < 0.01); the partial pressure of oxygen in the arterial blood (PaO(2)) was 89.9 +/- 7 mm Hg, significantly higher than that before the PTE (54.5 +/- 7.7 mm Hg, P < 0.01),; and the arterial oxygen saturation (SaO(2)) was 96.5 +/- 1.8%, significantly higher than that before the PTE (90 +/- 4.3%, P < 0.05). During the follow-up there were 2 late deaths, and the cardiac function was graded as NYHA class I in 22 patients, as NYHA class II in 9 patients, and as NYHA class III in 1 patient.

CONCLUSION

DHCA is a necessary and elementary condition for PTE, and it is a key factor in promoting the effect of PTE to treat the pulmonary reflux injury and residual pulmonary hypertension properly.

目的

评估肺动脉血栓内膜剥脱术（PTE）在慢性血栓栓塞性肺动脉高压（CTEPH）治疗中的作用以及深低温停循环（DHCA）对其的影响。

方法

回顾1995年2月至2006年10月期间40例接受PTE治疗的CTEPH患者的临床资料，其中中央型25例，外周型15例；男性29例，女性11例；年龄46±12（20 - 70）岁。17例在深低温停循环下进行手术（A组），23例未采用深低温停循环（B组）。随访时间为41.8±36.4个月。

结果

围手术期，A组无患者死亡，B组有6例死亡。9例存在残余肺动脉高压，18例有严重肺反流损伤。PTE术后72小时，肺动脉收缩压（PASP）为58.3±30.7 mmHg，显著低于PTE术前（91.4±38.4 mmHg，P < 0.05）；肺血管阻力（PVR）为357±278.7 dynes×sec⁻¹×cm⁻⁵，显著低于PTE术前（978±675.6 dynes×sec⁻¹×cm⁻⁵，P < 0.01）；动脉血氧分压（PaO₂）为89.9±7 mmHg，显著高于PTE术前（54.5±7.7 mmHg，P < 0.01）；动脉血氧饱和度（SaO₂）为96.5±1.8%，显著高于PTE术前（90±4.3%，P < 0.05）。随访期间有2例晚期死亡，22例患者心功能分级为纽约心脏协会（NYHA）I级，9例为NYHA II级，1例为NYHA III级。