CAJ | 학술논문

目的探讨经皮房间隔造口术治疗特发性肺动脉高压(IPAH)合并右心衰竭患者的效果.方法回顾性分析2014年3至7月在上海交通大学附属胸科医院采用经皮房间隔造口术治疗的5例重度IPAH合并右心衰竭患者的临床资料.其中,男性3例,女性2例;年龄(29.3±15.2)岁.患者术前经联合靶向药物治疗无效.房间隔造口均采用逐级球囊递增扩张法,术后对房间隔造口术效果进行评估.结果 5例患者均完成经皮房间隔造口术,无操作并发症.右心房平均压由术前的(18.9±1.7) mmHg(1 mmHg=0.133 kPa)下降至术后的(16.0±1.3) mmHg(P=0.039),主动脉氧饱和度由术前的(98.0±1.8)％下降至术后的(86.4±3.2)％(P=0.002),心指数由术前的(2.1±0.3)L·min-1·m-2上升至术后的(2.7±0.5)L·rain-1·m-2(p =0.029).术后随访(6.2±1.8)个月,术前心功能(世界卫生组织分级)3级3例,4级2例,术后患者的心功能均降低1级(P=0.062);6 rain步行距离由术前的(289.2±16.9)m提高至术后的(320.4±19.6)m(P =0.019);血浆B型利钠肽由术前的(550.0±35.7) ng/L下降至术后的(218.0 ±36.2)ng/L(P ＜0.001);超声心动图检查显示1例患者的房间隔造口处自发闭合,其余4例患者的房间隔造口处仍为右向左分流.结论房间隔造口术治疗合并右心衰竭患者的重度IPAH不仅安全,而且可改善血液动力学,提高心功能,但远期效果有待进一步研究.
목적 탐토경피방간격조구술치료특발성폐동맥고압(IPAH)합병우심쇠갈환자적효과.방법 회고성분석2014년3지7월재상해교통대학부속흉과의원채용경피방간격조구술치료적5례중도IPAH합병우심쇠갈환자적림상자료.기중,남성3례,녀성2례;년령(29.3±15.2)세.환자술전경연합파향약물치료무효.방간격조구균채용축급구낭체증확장법,술후대방간격조구술효과진행평고.결과 5례환자균완성경피방간격조구술,무조작병발증.우심방평균압유술전적(18.9±1.7) mmHg(1 mmHg=0.133 kPa)하강지술후적(16.0±1.3) mmHg(P=0.039),주동맥양포화도유술전적(98.0±1.8)％하강지술후적(86.4±3.2)％(P=0.002),심지수유술전적(2.1±0.3)L·min-1·m-2상승지술후적(2.7±0.5)L·rain-1·m-2(p =0.029).술후수방(6.2±1.8)개월,술전심공능(세계위생조직분급)3급3례,4급2례,술후환자적심공능균강저1급(P=0.062);6 rain보행거리유술전적(289.2±16.9)m제고지술후적(320.4±19.6)m(P =0.019);혈장B형리납태유술전적(550.0±35.7) ng/L하강지술후적(218.0 ±36.2)ng/L(P ＜0.001);초성심동도검사현시1례환자적방간격조구처자발폐합,기여4례환자적방간격조구처잉위우향좌분류.결론 방간격조구술치료합병우심쇠갈환자적중도IPAH불부안전,이차가개선혈액동역학,제고심공능,단원기효과유대진일보연구.
Objective To evaluate the efficacy of atrial septostomy in idiopathic pulmonary arterial hypertension(IPAH) patients complicating right ventricular failure.Methods This retrospective analysis included 5 IPAH patients (3 males,(29.3 ± 15.2) years old) with right ventricular failure which were refractory to conventional and target-specific medication in Shanghai Chest Hospital from March to July 2014.Graded balloon dilation septostomy procedures were performed in all 5 patients.Results Successful atrial septostomy was achieved in 5 attempts with no procedure-related complications.Immediately post procedure,the mean systemic oxygen saturation decreased from (98.0 ± 1.8) ％ to (86.4 ± 3.2) ％ (P =0.002),while the mean right atrial pressure decreased from(18.9 ± 1.7) mmHg(1 mmHg =0.133 kPa) to (16.0 ± 1.3)mmHg(P =0.039) and the mean cardiac index increased from (2.1 ±0.3)L · rain-1 · m-2 to (2.7 ± 0.5) L · min 1 · m-2 (p =0.029).Mean follow-up was (6.2 ± 1.8) months.Cardiac functional class (WHO) was 3 in 3 patients and 4 in 2 patients before the procedure,and increased 1 class in all patients during follow-up(P =0.062).Exercise endurance(6-min walk test)also improved from (289.2 ± 16.9)m to (320.4 ± 19.6) m (P =0.019),while B-type natriuretic peptide (BNP) level declined from (550.0 ± 35.7) ng/L to (218.0 ± 36.2) ng/L (P ＜ 0.001).Except one patient developed spontaneous closure of created defect,right to left shunt at atrial septal level was evidenced by echocardiography during follow-up in the rest 4 patients.Conclusions Atrial septostomy is safe and can improve hemodynamics and heart function in selected IPAH patients with right heart failure.Atrial septostomy can be used as a palliative treatment for IPAH and further study is warranted to evaluate the long-term efficacy of this procedure.