下腔静脉型布-加综合征PTA治疗前后血管内压力研究

Study of Blood Pressure Within the Vascellum Before and After PTA Treatment of the Obstructive Lesion of Inferior Vena Cava in Budd-Chiari Syndrome

目的研究下腔静脉型布-加综合征（BCS）介入治疗前后右心房、下腔静脉内压力变化规律,探讨血管内压力变化在BCS介入治疗中的临床意义。方法搜集下腔静脉型BCS患者共39例,行下腔静脉经皮腔内血管成形术（PTA）治疗。术前测量右心房、下腔静脉压力值,扩张后,留置导管监测右心房、下腔静脉压力变化至术后2 h。术后随访患者的临床症状及体征、彩色多普勒超声。结果39例患者PTA治疗均成功,下腔静脉平均压力术前（27.74±6.01）cm H_2O（1 cm H_2O=0.098 k Pa）与术后40 min（13.48±3.05）cm H_2O变化有明显差异（P〈0.05）,40min^2 h平均压力改变差异无统计学意义（P〉0.05）;平均跨膜压差在血管开通前（20.92±5.82）cm H_2O与开通后10 min（4.35±2.15）cm H_2O差异显著（P〈0.05）,而开通后10 min^2 h变化差异无统计学意义（P〉0.05）;其中30例临床症状、体征完全消失者开通后40 min平均跨膜压差（2.88±0.93）cm H_2O、下腔静脉平均压力（12.27±2.16）cm H_2O与9例明显改善者开通后40 min平均跨膜压差（6.67±1.41）cm H_2O、下腔静脉平均压力（17.56±1.74）cm H_2O比较差异有统计学意义（P〈0.05）。结论PTA治疗后跨膜压差对血管残余狭窄程度的判断比下腔静脉血压值更有意义。跨膜压差≤4 cm H_2O,40 min后下腔静脉压力≤16 cm H_2O可取得满意疗效。

Objective To investigate the pressure changes in right atrium and inferior vena cava in the obstructive lesion of inferior vena cava in Budd-Chiari syndrome（BCS）before and after percutaneous transluminal angioplasty（PTA）therapy,and to further explore the significance of blood pressure changes in interventional treatment of BCS.Methods 39cases with the obstructive lesion of inferior vena cava in BCS were treated by PTA during the period from March to November,2009.Firstly,the pressure values of right atrium,inferior vena cava were measured before treatment.Then,the lesions were treated by balloon dilatation.Using catheter directed monitored pressure variation of right atrium and inferior vena cava for 2 hours after the opening.After the operation,made a follow-up visit to assess the patients’clinical symptoms,signs,CDFI and blood coagulation.ResultsOf all cases 39 were operated by inferior vena cava PTA.There were significant differences in inferior vena cava pressure changes between before opening（27.74±6.01）cm H_2O and after 40 minutes（13.48±3.05）cm H_2O（P〈0.05）,but no significant differences from 40 minutes to 120 minutes（P〉0.05）.Transmembrane pressure changes were significantly different between before opening（20.92±5.82）cm H_2O and after 10 minutes（4.35±2.15）cm H_2O（P〈0.05）,but no significant difference from opening 10 minutes to 120 minutes（P〉0.05）.Among the 30 cases of clinical symptoms and signs disappeared after the opening 40 minutes average transmembrane pressure（2.88±0.93）cm H_2O,inferior vena cava pressure average（12.27±2.16）cm H_2O and 9 cases obviously improved after the opening 40 minutes average transmembrane pressure（6.67±1.41）cm H_2O,average pressure of inferior vena cava（17.56±1.74）cm H_2O was significantly different（P〈0.05）.ConclusionThe transmembrane pressure difference between the lesion after PTA therapy is more significant in evaluating for degree of residual stenosis than the value of blood pressure of inferior vena cava.It may obtain the satisfactory effect if the transmembrane pressure difference is less than 4 cm H_2O after the operation,the pressure value reduces at least to below 16 cm H_2O in the inferior vena cava after40 minutes.