摘要
目的分析术前慢性栓塞性肺动脉高压（CTEPH）患者可手术性评估的结果,探讨评估CTEPH可手术病变与高肺血管阻力（PVR）不符的方法。方法将2002年3月至2010年5月北京安贞医院收治的133例CTEPH患者纳入可手术性分析程序,其中男86例,女47例;年龄17~72岁（49.10±22.70岁）。按术前CTEPH患者可手术性评估程序将133例患者分为可手术组（A组,n=82,年龄47.80±21.60岁）和不可手术组（B组,n=51,年龄50.30±23.40岁）。两组患者入院后用核素肺通气灌注扫描和肺动脉CT造影检测并计算CTEPH导致的阻塞肺动脉段（OPS）,检测血浆氨基末端B型利钠肽前体（NT-pro BNP）和PVR,计算NT-pro BNP/OPS和PVR/OPS。结果 A组82例患者进行了全身麻醉试验,其中81例麻醉试验阳性,施行肺动脉血栓内膜剥脱术（PTE）治疗,1例围术期死于持续性残余肺动脉高压和右心功能衰竭,全身麻醉试验特异性为98.78%。术后随访80例（98.77%）,随访时间1~95个月（42.70±28.40个月）,死于肺动脉高压危象1例。B组51例CTEPH患者中手术不可探及病变32例（62.75%）,合并严重疾病13例（25.49%）,PVR过高而与手术可探及病变不成比例6例（11.76%）。A组81例全身麻醉试验阳性患者的NT-proBNP/OPS为80~150 pg.ml-1/OPS,PVR/OPS为50~100 dyn.s.cm-5/OPS。B组6例高PVR与手术可探及病变不成比例而未手术患者的NT-pro BNP/OPS（315.00±83.00 pg.ml-1/OPS vs.115.60±40.50 pg.ml-1/OPS,P=0.000）和PVR/OPS（190.00±57.00 dyn.s.cm-5/OPS vs.76.40±26.30 dyn.s.cm-5/OPS,P=0.000）明显高于A组全身麻醉试验阳性患者。结论外周型CTEPH手术不可探及病变、合并严重疾病、手术可探及病变与PVR严重不一致是三种最常见的不可手术情况。NT-pro BNP/OPS、PVR/OPS可作为评估手术可探及病变与PVR严重不一致的指标。全身麻醉试验可作为手术前最后的可手术性评估方法。
Objective To analyze the results of preoperative evaluation of the operability of chronic thromboembolic pulmonary hypertension（CTEPH）,and to find parameters to define the inconsistency between the operable lesions of CTEPH and pulmonary vascular resistance（PVR）.Methods A total of 133 patients with CTEPH admitted into Anzhen Hospital were enrolled for preoperative assessment of operability from March 2002 to May 2010.There were 86 males and 47 females with an age of 49.10±22.70 years.The patients were divided into operable group（group A,n=82,age of 47.80±21.60 years） and inoperable group（group B,n=51,age of 50.30±23.40 years） according to the assessment suggestion.We evaluated the occluded pulmonary segment（OPS） of all the patients through pulmonary ventilation/perfusion scintigraphy,and measured the plasma amino-terminal B-type natriuretic peptide（NT-pro BNP） and PVR.Then the ratio of NT-pro BNP to OPS and PVR to OPS were calculated.Results Out of the 82 patients with CTEPH in group A,81 were positive in the anesthesia test and were subject to pulmonary thromboendarterectomy（PTE）.In the whole cohorts of operated patients,there was one early death due to persistent pulmonary hypertension and right heart failure.The specificity of the anesthesia test was 98.78%.Eighty patients（98.77%） were followed up in this group for a period of 1 to 95 months（42.70±28.40 months）.During the follow-up,there was one late death due to pulmonary artery hypertension crisis.Among the 51 patients with CTEPH in group B,there were 32 patients（62.75%） with surgically inaccessible lesions,13 patients（25.49%） with surgical accessible CTEPH concomitant with severe diseases,and 6 patients（11.76%） with inconsistency between the surgical accessible lesion and high PVR.The ratio of NT-pro BNP to OPS and PVR to OPS for the 81 positive patients in group A was in the range of 80-150 pg·ml-1/OPS and 50-100 dyn·s·cm-5/OPS,respectively.The ratio of NT-pro BNP to OPS（315.00±83.00 pg·ml-1/OPS vs.115.60±40.50 pg·ml-1/OPS,P=0.000） and PVR to OPS（190.00±57.00 dyn·s·cm-5/OPS vs.76.40±26.30 dyn·s·cm-5/OPS,P=0.000） for the 6 patients with incosistency between the surgical accessible lesion and high PVR in group B were significantly higher than that for the 81 positive patients in group A.Conclusion Surgically inaccessible CTEPH lesions,CTEPH concomitant with severe diseases,and inconsistency between surgical accessible lesion and high PVR are the three most frequent reasons for denying PTE procedure.The ratio of NT-pro BNP to OPS and PVR to OPS may serve as the parameters to define the inconsistency between the surgical accessible lesion and high PVR.Anesthesia test before the PTE procedure may serve as the last evaluation method for the assessment of the operability of CTEPH.
出处
《中国胸心血管外科临床杂志》
CAS
2011年第3期199-203,共5页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
国家自然科学基金资助项目(81070041)~~
关键词
慢性栓塞性肺动脉高压
氨基末端B型利钠肽前体
肺血管阻力
Chronic thromboembolic pulmonary hypertension
Amino-terminal B-type natriuretic peptide
Pulmonary vascular resistance
