肺动脉内膜剥脱术56例围手术期处理和结果报告

Peri-operative Management and Result of Pulmonary Endarterectomy in 56 Patients

目的:总结慢性血栓栓塞性肺动脉高压(CTEPH)患者肺动脉内膜剥脱术(PEA)围手术期的处理经验。方法:回顾性分析2015-01至2016-11本中心56例CTEPH患者PEA围手术期的处理方法,包括术后重症监护室治疗期间对患者呼吸系统和循环系统的用药调整、围手术期血管活性药物和肺动脉高压靶向药物的使用、呼吸机的使用、机械辅助装置的使用以及其他特殊的围手术期处理经验等。结果:56例患者围手术期无死亡,术后2例(3.6%)患者出现灌注肺,2例(3.6%)患者出现肺动脉高压危象。患者术后肺动脉血流动力学指标与术前相比,差异均有统计学意义(P均<0.01):右心导管测肺动脉收缩压从术前(85.05±22.40)mmHg(1 mmHg=0.133 kPa)降低至术后末次(36.83±17.21)mmHg,肺血管阻力从术前(773.84±342.95)dyn·s·cm^(-5)降低至术后末次(293.59±214.95)dyn·s·cm^(-5)。所有患者术后指氧饱和度均维持在95%~100%。超声心动图检查发现,肺动脉收缩压从术前的(85.03±25.78)mmHg降低至随访时(39.44±19.24)mmHg,差异有统计学意义(P<0.01)。结论:对于CTEPH患者,完善的围手术期处理方案有利于改善其肺血流动力学指标,同时针对严重并发症的预防及处理可明显降低围手术期死亡率。

Objective： To summarize the pert-operative management experience of pulmonary endarterectomy （PEA） in patients with chronic thromboembolic pulmonary hypertension （CTEPH）. Methods： A total of 56 CTEPH patients received PEA in our hospital from 2015-01 to 2016-11 were retrospectively analyzed. Our study was focused on the medication in respiratory and circulatory system during iCU stay, pert-operative application of vasoactive drug and target drug to pulmonary hypertension （HP）, usage of ventilators, mechanical assisted devices and other management experiences. Results： No pert-operative death occurred. There were 2/56 （3.6%） patients with lung reperfusion, 2 （3.6%） with PH crisis. Compared with pre-operation, the post-operative pulmonary artery hemodynamics parameters were improved as right heart catheter measured pulmonary artery systolic pressure （PASP） decreased from （85.05±22.40） mmHg to （36.83 ±17.21） mmHg and pulmonary vascular resistance decreased from （773.84±342.95） dyn·s·cm^-5 to （293.59±214.95） dyn·s·cm^-5. Post- operative oxygen saturation was maintained at （95-100） % in all patients. Echocardiography found that PASP from pre- operation （85.03±25.78） mmHg decreased to （39.44±19.24） mmHg at follow-up period, P〈0.01. Conclusion： A comprehensive peri-operative management of PEA was helpful to improve pulmonary hemodynamics in CTEPH patients; meanwhile, effective prevention and treatment of severe complication could obviously reduce peri-operative mortality.