肺动脉血栓内膜剥脱术的远期疗效

目的　观察肺动脉血栓内膜剥脱术 (PTE)对慢性栓塞性肺动脉高压 (CTEPH )患者的远期疗效。方法　 1997年 3月～ 2 0 0 2年 6月 ,共对 15例CTEPH患者行PTE ,14例存活出院。其中 13例随访时间平均 4 0 (17～ 77)个月 ,1例失访 ;随访项目包括心功能状态、血气分析和通过超声心动图测量肺动脉收缩压。结果　随访期内 13例患者均存活 ,其术前心功能NYHA分级均为Ⅲ、Ⅳ级 ;术后 12例患者心功能NYHA分级Ⅰ级、1例Ⅲ级 ;动脉血氧分压 (PaO2 )由术前的 (5 8 1± 8 6 )mmHg上升至(90 8± 6 0 )mmHg (P <0 0 1) ;动脉血氧饱和度由术前的 (90± 5 ) %上升至 (96± 1) % (P <0 0 5 ) ;肺动脉收缩压由术前的 (97 1± 2 2 4 )mmHg下降至 (4 2 6± 10 7)mmHg (P <0 0 1)。结论　肺动脉血栓内膜剥脱术对慢性栓塞性肺动脉高压患者具有很好的远期疗效 ,它能显著改善患者的心肺功能 ,提高其生活质量

Long term outcome after pulmonary thromboendarterectomy

OBJECTIVE: To evaluate the long term effect of pulmonary thromboendarterectomy (PTE) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). METHODS: From Mar 1997 to Jun 2002 at Fuwai Hospital, 14 patients with CTEPH underwent PTE and survived. One of them lost contact and the remaining 13 patients were followed up for a mean of 40 (17 - 77) months. The parameters included survival rate, cardiac function, arterial gas analysis and systolic pulmonary artery pressure (SPAP) calculated by echocardiogram. RESULTS: In the period of follow-up no patient died. Before PTE the cardiac function were severely impaired (NYHA classes III-IV) in all patients, while during the follow-up 12 cases were in NYHA class I and 1 in NYHA class III. Compared with preoperative values, the postoperative arterial pressure of oxygen (PaO2) significantly improved (90.8 +/- 6.0) mm Hg vs (58.1 +/- 8.6) mm Hg, (P < 0.01), so was the arterial oxygen saturation (96 +/- 1)% vs (90 +/- 5)%, (P < 0.05), while systolic pressure of pulmonary artery decreased significantly (97.1 +/- 22.4) mm Hg vs (42.6 +/- 10.7) mm Hg, (P < 0.01). CONCLUSION: PTE provides substantial improvement in survival, function and quality of life in most CTEPH patients.