肺动脉栓塞外科治疗54例临床分析

摘要

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.%Objective To evaluate the results of surgical procedures for pulmonary embolism.Methods Fifty-four patients of pulmonary embolism received surgical treatment from Octaber 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 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,tllere were 4 patients died.According to NYHA,tIlere 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.