肺动脉栓塞外科治疗54例临床分析

目的 探讨肺动脉栓塞外科治疗的疗效.方法 回顾性分析1994年10月至2007年6月54例接受手术治疗的肺动脉栓塞患者的临床资料.急性肺动脉栓塞组9例,在中低温体外循环下行肺动脉切开取栓术;慢性栓塞性肺动脉高压组45例,在深低温下行肺动脉血栓内膜剥脱术.结果 急性肺动脉栓塞组围手术期死亡率(44.4%)高于慢性肺动脉栓塞组(13.3%)(P＜0.05).全组患者术后残余肺动脉高压13例,重度肺组织再灌注损伤23例.术后肺动脉收缩压和肺血管阻力均较术前下降,动脉血氧分压和动脉血氧饱和度较术前改善(P＜0.05).44例围手术期生存患者平均随访(41.8±36.4)个月.晚期死亡4例.全组抗凝相关出血线性发生率为0.63%人年,再发肺动脉栓塞线性发生率为0.62%人年.术后40例长期生存患者中,心功能(NYHA)Ⅰ级28例、Ⅱ级10例、Ⅲ级2例.结论 急性肺动脉栓塞围手术期死亡率显著高于慢性肺动脉栓塞.肺动脉栓塞外科治疗术后有较好的中长期生存率,抗凝相关的出血并发症及再发肺动脉栓塞的发生率较低.

The clinical analysis of 54 cases for the surgical treatment of pulmonary embolism

OBJECTIVE: To evaluate the results of surgical procedures for pulmonary embolism. METHODS: Fifty-four patients of pulmonary embolism received surgical treatment from October 1994 to June 2007, of which 9 were acute pulmonary embolism underwent pulmonary embolectomy and 45 patients were chronic thromboembolic pulmonary hypertension (CTEPH) underwent pulmonary thromboendarterectomy. RESULTS: The mortality rate was 44.4% in acute pulmonary embolism group and 13.3% in CTEPH group (P < 0. 05). Thirteen patients had residual pulmonary hypertension and 23 patients had severe pulmonary reperfusion injury postoperatively. The pulmonary artery systolic pressure changed from (89.4 +/- 36.3) mm Hg (1 mm Hg =0.133 kPa) preoperative to (55.6 +/- 22.4) mm Hg postoperative. The pulmonary vascular resistance changed from (89. 7 +/- 56.7) kPa L(-1) S(-1) preoperative to (38.9 +/- 31.1) kPa L(-1) S(-1) postoperative. The arterial partial pressure of oxygen changed from (52. 3 +/- 6.7 ) mm Hg preoperative to (87.6 +/- 6.5) mm Hg postoperative. The arterial oxygen saturation changed from (88.9 +/- 4.5)% preoperative to (95.3 +/- 2.8 )% postoperative (P < 0.05). With the follow-up of (41.8 +/- 36.4) months, there were 4 patients died. According to NYHA, there were 28 patients for class I , 10 patients for class II and 2 patients for class III. According to Kaplan-Meier survival curve, the 3-year, 4-year, 5-year and 8-year survival rate were (97.1 +/- 2.8 )%, (94.0 +/- 4.1)%, (90.8 +/- 5.2)% and (85.0 +/- 7.3)% respectively. Linear rate of bleeding and thromboembolic related to anticoagulation were 0. 63% patient-years and 0. 62% patient-years respectively. CONCLUSIONS: The operational mortality of acute pulmonary embolism is significantly higher than CTEPH, and the mid-long term survival rate is agreeable and the complication rate related to anticoagulation is relatively low.