慢性肺动脉血栓栓塞患者手术治疗效果分析
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摘要
目的回顾分析亚洲人慢性肺动脉血栓栓塞患者手术治疗效果。方法回顾分析2000至2006年应用肺动脉血栓内膜剥脱术(PEA)治疗慢性肺动脉血栓栓塞患者15例的围术期处理及近期结果。记录术前、术后超声心动测量平均肺动脉收缩压,术前、术后左心室射血分数,术前、术后右心室左心室容积比,并进行相关性分析。结果术后超声心动测肺动脉收缩压[(28.40±8.06)mm Hg]比术前[(62.85±18.08)mm Hg]显著降低(P<0.05)。右心室左心室容积比由术前(1.24±0.39)%显著降低为(0.66±0.17)%,差异有统计学意义(P<0.05)。左心室射血分数术前术后变化不明显,差异无统计学意义(P>0.05)。结论肺动脉内膜剥脱术是治疗慢性肺动脉血栓栓塞的有效方法,它能显著改善患者的心肺功能,提高生活质量。
Objective To analyze retrospectively the therapeutic effects on chronic pulmonary thromboembolism in Asian. Methods The clinical data about 15 patients with chronic pulmonary thromboembolism who were treated by pulmonary artery endarterectomy( PEA) in our hospital from 2000 to 2006 were retrospectively analyzed. The mean pulmonary artery systolic blood pressure( mm Hg),left ventricular ejection fraction( 100%) and the volume ratio of right ventricle vs left ventricle( 100%) before and after operation were observed and analyzed. Results After operation,the systolic pressure of pulmonary artery [( 28. 40 ± 8. 06) mm Hg] was significantly decreased,as compared with that [( 62. 85 ± 18. 08) mm Hg]before operation( P < 0. 05). After operation the volume ratio of right ventricular vs left ventricle [( 0. 66 ± 0. 17) %] was significantly decreased,as compared with that [( 1. 24 ± 0. 39) %] before operation( P < 0. 05). However there were no significant differences in the changes of left ventricular ejection fraction before and after operation( P > 0. 05). Conclusion The pulmonary artery endarterectomy is an effective method in treatment of chronic pulmonary thromboembolism,which can significantly improve the cardiopulmonary function and improve life quality of patients with chronic pulmonary thromboembolism.
Objective To analyze retrospectively the therapeutic effects on chronic pulmonary thromboembolism in Asian. Methods The clinical data about 15 patients with chronic pulmonary thromboembolism who were treated by pulmonary artery endarterectomy( PEA) in our hospital from 2000 to 2006 were retrospectively analyzed. The mean pulmonary artery systolic blood pressure( mm Hg),left ventricular ejection fraction( 100%) and the volume ratio of right ventricle vs left ventricle( 100%) before and after operation were observed and analyzed. Results After operation,the systolic pressure of pulmonary artery [( 28. 40 ± 8. 06) mm Hg] was significantly decreased,as compared with that [( 62. 85 ± 18. 08) mm Hg]before operation( P < 0. 05). After operation the volume ratio of right ventricular vs left ventricle [( 0. 66 ± 0. 17) %] was significantly decreased,as compared with that [( 1. 24 ± 0. 39) %] before operation( P < 0. 05). However there were no significant differences in the changes of left ventricular ejection fraction before and after operation( P > 0. 05). Conclusion The pulmonary artery endarterectomy is an effective method in treatment of chronic pulmonary thromboembolism,which can significantly improve the cardiopulmonary function and improve life quality of patients with chronic pulmonary thromboembolism.
引文
1 Agnelli G,Becattini C.Acute pulmonary embolism.Engl J Med,2010,363:266-274.
2 Kunihara T,Gerdts J,Groesdonk H,et al.Predictors of postoperative outcome after pulmonary endarterectomy from a 14-year experience with279 patients.Eur J Cardiothorac Surg,2011,40:154-161.
3 黎秀文,林艺,王力鹏,等.CT肺动脉栓塞指数在老年急性肺栓塞患者临床诊断中的意义.疑难病杂志,2016,25:150-153.
4 柳志红.慢性血栓栓塞性肺动脉高压的处理.中国循环杂志,2011,4:243-244.
5 甘辉立,张健群,穆军升,等.肺动脉栓塞外科治疗的围术期及中长期效果分析.中国胸心血管外科临床杂志,2008,15:1-6.
6 吴仁昌,白荣杰.CT血管造影在肺动脉栓塞诊断中的价值.黑龙江医学,2007,31:801-802.
7 杨馨.多层螺旋CT血管成像技术在肺动脉栓塞诊断中的价值.中国民康医学,2010,22:1680-1683.
8 吕飙,张兆琪,王珏.螺旋CT增强扫描在诊断和治疗肺动脉栓塞中的应用.中华胸心血管外科杂志,2001,17:198-200.
9 张运剑,陆慰萱.慢性血栓栓塞性肺动脉高压的现状与进展.中国危重病急救医学,2004,1:506-509.
10 吴清玉,吴永波.慢性栓塞性肺动脉高压的外科治疗.中华心血管病杂志,2001,29:269-270.
11 康桂艳,张久山.肺动脉栓塞诊治进展.右江医学,2004,32:159-161.
12 甘辉立,张健群.慢性栓塞性肺动脉高压的手术治疗(一)——慢性栓塞性肺动脉高压的可手术性判断.中华胸心血管外科杂志,2001,17:198-200.
13 Meyer G,Roy PM,Gilberg S,et al.Pulmonary embolism.BMJ,2010,340:974-975.
14 甘辉立,张健群,刘双.肺动脉血栓内膜剥脱术连续62例无死亡报告.中华医学杂志,2009,89:1330-1333.
15 British Cardiac Society Guidelines,Medical Practice Committee.Recommendations on the management of pulmonary hypertension in clinical practice.Heart,2001,86:11-13.
16 Felderhoff T.Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension.Herz,2005,30:274-280.
2 Kunihara T,Gerdts J,Groesdonk H,et al.Predictors of postoperative outcome after pulmonary endarterectomy from a 14-year experience with279 patients.Eur J Cardiothorac Surg,2011,40:154-161.
3 黎秀文,林艺,王力鹏,等.CT肺动脉栓塞指数在老年急性肺栓塞患者临床诊断中的意义.疑难病杂志,2016,25:150-153.
4 柳志红.慢性血栓栓塞性肺动脉高压的处理.中国循环杂志,2011,4:243-244.
5 甘辉立,张健群,穆军升,等.肺动脉栓塞外科治疗的围术期及中长期效果分析.中国胸心血管外科临床杂志,2008,15:1-6.
6 吴仁昌,白荣杰.CT血管造影在肺动脉栓塞诊断中的价值.黑龙江医学,2007,31:801-802.
7 杨馨.多层螺旋CT血管成像技术在肺动脉栓塞诊断中的价值.中国民康医学,2010,22:1680-1683.
8 吕飙,张兆琪,王珏.螺旋CT增强扫描在诊断和治疗肺动脉栓塞中的应用.中华胸心血管外科杂志,2001,17:198-200.
9 张运剑,陆慰萱.慢性血栓栓塞性肺动脉高压的现状与进展.中国危重病急救医学,2004,1:506-509.
10 吴清玉,吴永波.慢性栓塞性肺动脉高压的外科治疗.中华心血管病杂志,2001,29:269-270.
11 康桂艳,张久山.肺动脉栓塞诊治进展.右江医学,2004,32:159-161.
12 甘辉立,张健群.慢性栓塞性肺动脉高压的手术治疗(一)——慢性栓塞性肺动脉高压的可手术性判断.中华胸心血管外科杂志,2001,17:198-200.
13 Meyer G,Roy PM,Gilberg S,et al.Pulmonary embolism.BMJ,2010,340:974-975.
14 甘辉立,张健群,刘双.肺动脉血栓内膜剥脱术连续62例无死亡报告.中华医学杂志,2009,89:1330-1333.
15 British Cardiac Society Guidelines,Medical Practice Committee.Recommendations on the management of pulmonary hypertension in clinical practice.Heart,2001,86:11-13.
16 Felderhoff T.Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension.Herz,2005,30:274-280.