摘要
目的分析慢性栓塞性肺动脉高压(CTEPH)患者应用肺动脉血栓内膜剥脱术(PTE)治疗的围手术期及中、晚期效果。方法选择CTEPH患者81例,按临床病理分型分为中央型组60例和外周型组21例,在深低温停循环下行PTE,随访5年,观察生存率。回顾性按年龄将患者分为老年组(≥60岁,19例)和非老年组(<60岁,62例),比较2组早期及晚期生存率。结果中央型组围手术期死亡1例。外周型组患者体外循环时间、主动脉阻断时间、深低温停循环时间均显著长于中央型组;围手术期肺动脉高压危象发生率显著高于中央型组,肺再灌注损伤发生率显著低于中央型组;肺动脉收缩压、肺循环阻力显著高于中央型组(P<0.05,P<0.01)。随访期间1例死亡,5年生存率为98.77%。老年组与非老年组术后早期及晚期生存率差异无统计学意义(P>0.05)。结论 PTE治疗CTEPH患者有较好的围手术期及中、晚期生存率,老年患者术后早期及晚期生存率与非老年患者无显著差异。术前准确评估,可提高PTE早期及中、晚期生存率。
Objective To analyse the efficacy of pulmonary thromboendarterectomy（PTE） in treat- ment of patients with chronic thromboembolic pulmonary hypertension （CTEPH）. Methods Eighty-one cases of CTEPH underwent PTE and were divided into proximal CTEPH group （Group I , n= 60） and distal CTEPH group（Group II , n = 21）according to the pathological clas- sification of the CTEPH. They were also divided into elderly group（≥60 year, n = 19） ,and nonelderly group（〈60 year, n = 62）. Results The duration for cardiopulmonary bypass,clamping, and deep hypothermia circulatory arrest were significantly longer in Group Ⅱ than in Group I （P 〈 0.01）. The incidence of pulmonary hypertension crisis was significantly higher in Group Ⅱ than in Group I ,whereas the incidence of postoperative pulmonary reperfusion injury was signifi- cantly higher in Group I than in Group Ⅱ （P 〈 0.05, P 〈0.01）. The pulmonary artery systolic pressure and pulmonary vascular resistance were significantly higher in Group Ⅱ than in Group I. The difference of the early and late mortality between the elderly group and non-elderly group did not reach statistical significance （P 〉 0.05）. Conclusion The early- and midterm survival rates of CTEPH patients undergoing PTE were agreeable and the complication rate related to anticoagulation with warfarin was relatively low. There was no significant difference in the early and late mortality between the elderly group and non-elderly group. Proper operability evaluation contributes to agreeable early and late survival of the patients undergoing PTE.
出处
《中华老年心脑血管病杂志》
CAS
北大核心
2011年第1期45-49,共5页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
基金
国家自然科学基金(81070041)
关键词
肺栓塞
动脉内膜切除术
高血压
肺性
再灌注损伤
pulmonary embolism
endarterectomy
hypertension, pulmonary
reperfusion injury
