球囊肺动脉成形术治疗近端慢性血栓栓塞性肺动脉高压的安全性和有效性

The safety and efficacy of balloon pulmonary angioplasty in the treatment of proximal-type chronic thromboembolic pulmonary hypertension

目的 评估球囊肺动脉成形术(BPA)治疗近端慢性血栓栓塞性肺动脉高压(CTEPH)的安全性和有效性。方法 纳入2016年12月至2022年1月在中日友好医院呼吸中心住院的CTEPH患者46例,均接受BPA。比较术前与术后患者的WHO心功能分级、6 min步行距离(6MWD)、血N-末端脑钠肽前体(NT-proBNP)水平、混合静脉血氧饱和度(SvO_(2))、平均肺动脉压(mPAP)、心指数和肺血管阻力(PVR)。结果 46例行BPA治疗的CTEPH患者中,男性17例,女性29例,年龄(57.0±12.7)岁。行126次BPA,共治疗545支病变血管,平均每次治疗血管数2.7支。术前患者的WHO心功能Ⅰ、Ⅱ、Ⅲ、Ⅳ级分别为1例(2.2%)、24例(52.1%)、17例(37.0%)、4例(8.7%),6MWD为(359.6±112.3) m,SvO_(2)为(64.5±8.8)%;术后WHO心功能Ⅰ、Ⅱ、Ⅲ、Ⅳ级分别为6例(13.0%)、31例(67.4%)、13例(28.3%)、2例(4.3%),6MWD为(436.7±97.9) m,SvO_(2)为(66.4±5.5)%(均P<0.05)。术后血浆NT-proBNP、mPAP、PVR、心指数、右心房压力均低于术前,分别为262(145,746) ng/L比955(242,2781) ng/L、(29.2±9.9) mmHg比(39.4±9.5) mmHg、(6.6±2.7)WU比(12.1±6.2)WU、(1.1±0.7) L/(min·m^(2))比(1.7±0.8) L/(min·m^(2))、(3.7±3.0) mmHg比(5.1±4.4) mmHg(均P<0.05)。咯血共5例次,再灌注肺水肿1例次,无其他并发症发生。结论 BPA是治疗近端CTEPH患者安全、有效的方法。

Objective To evaluate the safety and efficacy of balloon pulmonary angioplasty(BPA)in treating proximal-type chronic thromboembolic pulmonary hypertension(p-CTEPH).Methods A total of 46 patients with p-CTEPH,who were admitted to the China-Japan Friendship Hospital of China between December 2016 and January 2022 to receive BPA,were enrolled in this study.The postoperative World Health Organization cardiac functional class(WHO-FC),6-min walk distance(6-MWD),plasma level of N-terminal pro-brain natriuretic peptide(NT-proBNP),mixed venous oxygen saturation(SvO_(2)),mean pulmonary artery pressure(mPAP),cardiac index(CI)and pulmonary vascular resistance(PVR)were compared with the preoperative ones.Results The 46 CTEPH patients included 17 males and 29 females with a mean age of(57.0±12.7)years.A total of 126 BPA procedures were performed and a total of 545 diseased vessels were treated,with a mean of 2.7(1,8.15)vessels per BPA procedure.Before treatment,the preoperative WHO-FC grade I was seen in one patient(2.2%),grade I in 24 patients(52.1%),grade II in 17 patients(37.0%)and grade IV in 4 patients(8.7%),the 6-MWD was(359.6±112.3)m,and the mean Sv02 was(64.5±8.8)%;after treatment,the WH0-FC grade I was seen in 6 patients(13.0%),grade II in 31 patients(67.4%),grade II in 13 patients(28.3%)and grade IV in 2 patients(4.3%),the 6-MWD was(436.7±97.9)m,and the mean Sv02 was(66.4±5.5)%;the differences in the above indexes between their preoperative values and postoperative values were statistically significant(all P<0.05).The postoperative NT-proBNP,mPAP,PVR,CI and right atrial pressure were 262(145,746)ng/L,(29.2±9.9)mmHg,(6.6±2.7)WU,(1.1±0.7)L/(min·m^(2)),and(3.7±3.0)mmHg respectively,which were remarkably lower than the preoperative 955(242,2781)ng/L,(39.4±9.5)mmHg,(12.1±6.2)WU,(1.7±0.8)L(min:m^(2)),and(5.1±4.4)mmHg respectively,and the differences in all the above indexes between their preoperative values and postoperative values were statistically significant(all P<0.05).Five patients developed hemoptysis,one patient developed reperfusion pulmonary edema,and no other complications occurred.Conclusion For patients with p-CTEPH,BPA is a clinically safe and effective treatment.