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Eur J Cardio-Thorac Surg:肺动脉高压是否应作为肺减容术的禁忌症?

2018-04-19 佚名 CardiothoracicSurge

一直以来肺动脉高压(PH)被认为是肺减容术(LVRS)的禁忌症。因为,有研究认为支气管镜下肺减容术并不会增加肺气肿合并PH患者的死亡率。来自瑞士的Claudio Caviezel教授等为了评估了PH对接受LVRS患者预后的影响,开展了一项研究,研究结果发表在近期的EJCTS杂志上。

一直以来肺动脉高压(PH)被认为是肺减容术(LVRS)的禁忌症。因为,有研究认为支气管镜下肺减容术并不会增加肺气肿合并PH患者的死亡率。来自瑞士的Claudio Caviezel教授等为了评估了PH对接受LVRS患者预后的影响,开展了一项研究,研究结果发表在近期的EJCTS杂志上。

研究者收集2014年1月至2016年6月,苏黎世大学医院接受LVRS的119例患者治疗。研究者认为PH对于均质性肺气肿患者来说是手术禁忌症,但对于那些异质性肺气肿的患者来讲并非绝对禁忌症。

在这组患者中30例患者在LVRS前后接受了超声心动图检查,其中10例患者术前收缩期肺动脉压>35mmHg,20例收缩期肺动脉压正常。研究者分析LVRS对肺动脉压,肺功能和患者生存率的影响。



30例患者的生存情况

研究发现,30例患者的90天死亡率为0,术后病程在两组间无显著差异。PH组患者,术后收缩期肺动脉压中位数从41mmHg [四分位间距(IQR)39-47] 降至37mmHg(IQR 36-38,P=0.04)。患者术后1个月的用力呼气量中位数从27%(IQR 23-34)提高到33%(IQR 28-40,P=0.007)。

所以,研究者认为,基于上诉的结果进一步证实,轻度至中度PH可能不应该作为异质性肺气肿患者LVRS的禁忌症。但是,该文作者纳入的患者较少,将来需要进一步大样本量的研究予以证实。

原始出处:
Claudio Caviezel, Carlson Aruldas, Daniel Franzen, et al. Lung volume reduction surgery in selected patients with emphysema and pulmonary hypertension. European Journal of Cardio-Thoracic Surgery. Mar 2018.

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    2018-04-21 秀红

    学习了

    0

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    2018-04-21 1209e435m98(暂无昵称)

    学习了.谢谢分享

    0

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    2018-04-20 yfjms

    学习

    0

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    2018-04-20 明天jing

    肺动脉高压表面是罕见病,事实上临床上并不少见,治疗药物虽然有一些,但是整体仍然不理解,可能未来需要采用综合治疗措施。

    0

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    2018-04-19 天地飞扬

    了解一下.谢谢分享!

    0

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