CAJ | 학술논문

目的总结肺动脉内膜剥脱手术的效果和临床经验,评价手术安全性及有效性.方法回顾性分析行肺动脉内膜剥脱手术的50例慢性血栓栓塞性肺动脉高压患者的临床资料.男38例,女12例;年龄(43.35±12.51)岁,病程(3.70±3.43)年,其中23例有下肢深静脉血栓形成病史.术前肺动脉收缩压(104.16±16.95) mmHg(1 mmHg=0.133 kPa),肺血管阻力(129.68±50.88) kPa·s·L-1(1kPa·s·L-1 =10dyn·s·cm-5),中心静脉压由术前(14.91±4.88) mmHg,心排血量(3.28±1.04)L/min.结果术中体外循环(294.37±94.01) min,主动脉阻断(127.93±35.57) min,停循环(34.30±21.74) min;术后机械通气(97.24±70.53)h,住ICU(9.52±12.96)天.患者术后肺动脉收缩压(54.11±16.86) mmHg,肺血管阻力(20.55±15.17) kPa·s·L-1,中心静脉压(9.00±3.09) mmHg,心排血量(5.75±1.48) L/min.术后死亡4例,死因为术后残余肺动脉高压和术后24 h内发生严重再灌注肺水肿、呼吸功能衰竭各2例.生存患者术后6个月随访显示,44例(95.7％)患者心功能(NYHA)恢复到Ⅰ级、Ⅱ级,生活质量明显改善.术后1年所有患者恢复正常工作和一般体力活动.结论深低温停循环下双侧肺动脉内膜剥脱手术可显著降低肺动脉压力和肺血管阻力,改善患者心肺功能.
목적 총결폐동맥내막박탈수술적효과화림상경험,평개수술안전성급유효성.방법 회고성분석행폐동맥내막박탈수술적50례만성혈전전새성폐동맥고압환자적림상자료.남38례,녀12례;년령(43.35±12.51)세,병정(3.70±3.43)년,기중23례유하지심정맥혈전형성병사.술전폐동맥수축압(104.16±16.95) mmHg(1 mmHg=0.133 kPa),폐혈관조력(129.68±50.88) kPa·s·L-1(1kPa·s·L-1 =10dyn·s·cm-5),중심정맥압유술전(14.91±4.88) mmHg,심배혈량(3.28±1.04)L/min.결과 술중체외순배(294.37±94.01) min,주동맥조단(127.93±35.57) min,정순배(34.30±21.74) min;술후궤계통기(97.24±70.53)h,주ICU(9.52±12.96)천.환자술후폐동맥수축압(54.11±16.86) mmHg,폐혈관조력(20.55±15.17) kPa·s·L-1,중심정맥압(9.00±3.09) mmHg,심배혈량(5.75±1.48) L/min.술후사망4례,사인위술후잔여폐동맥고압화술후24 h내발생엄중재관주폐수종、호흡공능쇠갈각2례.생존환자술후6개월수방현시,44례(95.7％)환자심공능(NYHA)회복도Ⅰ급、Ⅱ급,생활질량명현개선.술후1년소유환자회복정상공작화일반체력활동.결론 심저온정순배하쌍측폐동맥내막박탈수술가현저강저폐동맥압력화폐혈관조력,개선환자심폐공능.
Objective To evaluate the feasibility,validity and safety of pulmonary endarterectomy for patients with chronic thromboembolic pulmonary hypertension.Methods 50 patients undertook pulmonary endarterectomy operations were enrolled in this study.Of them,38 were males (76％),the average age was (43.35 ± 12.51) years,23 patients had deep venous thrombosis.Obvious pulmonary hypertension and hypoxemia were observed in all patients.Bilateral pulmonary endarterectomy was performed under cardiopulmonary bypass with profound hypothermic circulatory arrest.Preoperative systolic pulmonary artery pressure was(104.16 ± 16.95) mmHg,pulmonary vascular resistance was(129.68 ± 50.88) kPa · s · L-1,central venous pressure was (14.91 ± 4.88) mmHg,and cardiac output was (3.28 ± 1.04) L/min.Results The average time of cardiopulmonary bypass was(294.37 ± 94.01) min,aortic cross clamp time was(127.93 ± 35.57) min,circulatory arrest time was(34.30 ±21.74) min.Post-operative mechanical ventilation time was (97.24 ±70.53) hours,and the ICU stay was (9.52 ± 12.96) days.There were 4 patients that died after PEA surgery for postoperative residual pulmonary hypertension of reperfusion pulmonary edema.Post-operation,all patients had significant decrease in systolic pulmonary artery pressure (54.11 ± 16.86) mmHg and pulmonary vascular resistance(20.55 ± 15.17) kPa · s · L-1,and central venous pressure (9.00 ± 3.09) mmHg,and great improvement in cardiac output (5.75 ± 1.48) L/min.6-months follow-up showed that the cardiac function of 44 (95.7 ％) cases returned to NYHA class Ⅰ or Ⅱ,with great improvement in computed tomography pulmonary angiography.All patients go back to normal work and physical exercise at 1-year follow-up.Conclusion Conclusions According the successful experience of surgery for CTEPH patients,pulmonary endarterectomy for patients with CTEPH results in significant pulmonary hemodynamic improvement,with favorable outcomes of heart and lung function in short and middle time follow-up.