分次逐级经皮腔内球囊肺动脉瓣成形术在治疗慢性血栓栓塞性肺动脉高压患者中的临床疗效及安全性

Clinical efficacy and safety of sequential balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension

摘要:

目的]探讨分次逐级经皮腔内球囊肺动脉瓣成形术(BPA)治疗慢性血栓栓塞性肺动脉高压(CTEPH)患者的临床效果,并分析围手术期的安全性。 [方法]入选2018年8月—2024年2月于郑州大学附属洛阳中心医院行BPA治疗的30例CTEPH患者,选择药物治疗的30例CTEPH患者设为对照,收集患者的性别、年龄、体质指数、伴发疾病、血浆氨基末端脑钠肽前体(NT-proBNP)水平、肺动脉高压靶向药应用情况、6分钟步行试验距离(6-MWD)、WHO心功能分级资料及心脏超声肺动脉压相关数据。手术组行右心导管检查获得肺血管血流动力学相关参数。比较BPA术前、末次BPA术后和6个月随访时WHO心功能分级、6-MWD、NT-proBNP、肺血管血流动力学相关参数及心脏超声肺动脉压相关数据的变化以及在两组之间的差异。记录手术相关并发症(肺动脉损伤、造影剂肾病及再灌注肺水肿)的发生及处理结果。 [结果]与BPA术前相比,末次BPA术后心排出量(CO)、心脏指数(CI)和混合静脉血氧饱和度(SvO₂)升高,平均肺动脉压(mPAP)和肺血管阻力(PVR)降低(均P＜0.05),6-MWD、NT-proBNP、右心室直径、右心房上下径、右心房左右径、左心室舒张末内径及三尖瓣反流速度均得到改善(均P＜0.05)。与对照组相比,手术组6-MWD升高,NT-proBNP水平降低,右心室直径、右心房上下径及右心房左右径减小,左心室舒张末内径增大,三尖瓣反流速度降低,WHO心功能分级亦显著改善(均P＜0.05)。在30例BPA患者中,2例患者术中出现咯血,1例患者术后发生再灌注肺水肿,1例患者发生造影剂肾病,经治疗后均好转出院。 [结论]分次逐级BPA在治疗CTEPH患者中具有良好的临床疗效及安全性,是一种治疗CTEPH的有效技术,值得在临床中推广。

Abstract:

Aim To explore the clinical efficacy of sequential balloon pulmonary angioplasty (BPA) in the treatment of patients with chronic thromboembolic pulmonary hypertension (CTEPH), and analyze the safety during the perioperative period. Methods 30 patients with CTEPH who underwent BPA treatment at Luoyang Central Hospital affiliated to Zhengzhou University from August 2018 to February 2024 were selected, 30 patients with CTEPH who chose drug treatment were set as controls, the patients' gender, age, body mass index, comorbidities, plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, application of pulmonary hypertension targeted drugs, 6-minute walking distance (6-MWD), WHO cardiac function classification and cardiac ultrasound pulmonary arterial pressure related data were collected. Right heart catheterization was performed to obtain pulmonary hemodynamic parameters in the BPA group.Changes in WHO cardiac function classification, 6-MWD, NT-proBNP, pulmonary vascular hemodynamic parameters and cardiac ultrasound pulmonary artery pressure data before BPA, after the final BPA and at 6-month follow-up were compared, as well as differences between the two groups. The occurrence and management results of surgical complications such as pulmonary artery injury, contrast nephropathy and reperfusion pulmonary edema were recorded. Results Compared with before BPA, after the last BPA, cardiac output (CO), cardiac index (CI), and mixed venous oxygen saturation (SvO₂) increased, mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) decreased (all P＜0.05), and 6-MWD, NT-proBNP, right ventricular diameter, right atrial up-down diameter, right atrial left-right diameter, left ventricular diastolic end diameter, and tricuspid regurgitation velocity all improved (all P＜0.05). Compared with the control group, the surgical group showed an increase in 6-MWD, a decrease in NT-proBNP levels, a decrease in right ventricular diameter, right atrial up-down diameter and right atrial left-right diameter, an increase in left ventricular end diastolic diameter, a decrease in tricuspid regurgitation velocity and a significant improvement in WHO cardiac function classification (all P＜0.05). Among 30 BPA patients, 2 patients experienced hemoptysis during surgery, 1 patient developed reperfusion pulmonary edema after surgery, and 1 patient developed contrast nephropathy. After treatment, all patients improved and were discharged. Conclusion Sequential BPA has good clinical efficacy and safety in the treatment of CTEPH patients, and is an effective technique for treating CTEPH, which is worth promoting in clinical practice.