球囊肺动脉成形术对不能手术的慢性血栓栓塞性肺动脉高压夜间低氧的影响

Effect of balloon pulmonary angioplasty on nocturnal hypoxia in patients with inoperable chronic thromboembolic pulmonary hypertension

目的研究球囊肺动脉成形术(balloon pulmonary angioplasty,BPA)对不能手术的慢性血栓栓塞性肺动脉高压(chronic thromboembolic pulmonary hypertension,CTEPH)夜间低氧的影响。方法2020年7月-2022年10月在同济大学附属上海市肺科医院肺循环科确诊为CTEPH患者(n=60)纳入研究,随机分组为利奥西呱联合(n=36)或不联合(n=24)BPA进行干预,检测两组患者临床干预前后夜间低氧情况,明确BPA对CTEPH夜间低氧影响。结果BPA可明显改善CTEPH患者呼吸暂停低通气指数、夜间平均脉搏血氧饱和度(arterial oxygen saturation,SpO_(2))、夜间SpO_(2)低于90%的时间占总监测时间的百分比(T90%)及夜间最低SpO_(2),差异均有统计学意义(均P<0.05)。临床治疗干预后,BPA联合利奥西呱组T90%较利奥西呱组更低,差异有统计学意义(P=0.047);干预后,BPA联合利奥西呱组平均肺动脉压力(mean pulmonary artery pressure,mPAP)及肺血管阻力较药物组更低(均P<0.05);经双变量直线相关分析,BPA联合利奥西呱干预后,ΔMean SpO_(2)及ΔT90%均与ΔmPAP存在相关性(均P<0.05)。结论BPA可明显改善CTEPH患者夜间低氧,可能与血流动力学改善相关。

Objective To investigate the effect of balloon pulmonary angioplasty(BPA)on nocturnal hypoxia in patients with chronic thromboembolic pulmonary hypertension(CTEPH).Methods Sixty patients with CTEPH admitted at the Department of Pulmonary Circulation,Shanghai Pulmonary Hospital from July 2020 to October 2020 were enrolled in the study.Patients were randomly divided into two groups,patients in control group(n=24)were given riociguat for treatment and patients in study group(n=36)were treated with riociguat and BPA.Patients were followed up for 12 months,the apnea-hypopnea index(AHI),nocturnal mean SpO_(2)(Mean SpO_(2)),percentage of nocturnal SpO_(2) below 90% for total monitoring time(T90%)and minimum nocturnal SpO_(2)(Min SpO_(2))were observed in both groups.Results Twelve months after treatment,the nocturnal AHI,mean SpO_(2),T90% and Min SpO_(2) were improved in both groups(all P<0.05);while the T90% in study group was lower than that in the control group(P=0.047);an the mean pulmonary artery pressure(mPAP)and pulmonary vascular resistance were lower than those in the control group(both P<0.05).Bivariate linear correlation analysis revealed that post-intervention changes in Mean SpO_(2) and T90% were associated with changes in mPAP(both P<0.05).Conclusion BPA significantly improved nocturnal hypoxia in patients with CTEPH,which is possibly related to hemodynamic improvement.