肺血栓动脉内膜切除术患者的血流动力学和功能有效性

G. Valdez, Mayra Lucia Antonio, Adriana Alejandra Pineda
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引用次数: 0

摘要

目的:评价血栓动脉内膜切除术患者的血流动力学和功能效果。方法:对2002 ~ 2016年记录完整的系列血栓动脉内膜切除术患者进行描述性研究。数据收集采用“非专业”表格,包括人口学10项、躯体测量2项、血流动力学6项、功能测量1项、气体测量6项和灌注传导9项,均为开放和二分反应。资料分析采用描述性统计、Mann-Whitney检验和Kaplan-Meier生存分析;p <0.05为显著性。结果:25例患者,男性患病率(68%),年龄43±18岁。体外循环时间222±73 min,主动脉夹持时间121±71 min;在80%的情况下,循环骤停时间为20分钟,再灌注时间间隔为10分钟。20%的患者采用选择性脑灌注治疗。血栓动脉内膜切除术降低了肺血管阻力(p <0.0001)和平均肺动脉压(p = 0.001),增加了心输出量(p = 0.009)、PaO2 (p = 0.035)和SaO2 (p = 0.015)。72%的患者功能等级从III-IV级提高到I-II级。与肺动脉高压持续相关的死亡率为20%,三年生存率为80%。2例患者行ECMO A-V均成功。结论:血栓动脉内膜切除术是慢性肺血栓栓塞患者的首选治疗方法,可显著改善其血流动力学和功能参数,反映在其生活质量和生存率上。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Hemodynamic and functional effectiveness of the patient undergoing pulmonary thromboendarterectomy
Objective: to evaluate the hemodynamic and functional effectiveness of the patient undergoing thromboendarterectomy. Methods: a descriptive study of series of cases in postoperative patients of thromboendarterectomy from 2002 to 2016 with complete records was carried out. The data collection was done with an "ex profeso" sheet of 10 demographic items, 2 of somatometry, 6 hemodynamics, 1 functional, 6 gasometric and 9 of perfusion conduction, with open and dichotomous responses. For the data analysis, descriptive statistics, U Mann-Whitney tests and Kaplan-Meier survival analysis were applied; the significance was set at p <0.05. Results: 25 patients were studied, male prevalence (68%), age 43 ± 18 years. The cardiopulmonary bypass time was 222 ± 73 min. and the aortic clamp of 121 ± 71 min; in 80%total circulatory arrest was performed for periods of 20 min and reperfusion times of 10 min between each one. 20% of the patients were managed with selective cerebral perfusion. Thromboendarterectomy decreased pulmonary vascular resistance (p <0.0001) and mean pulmonary arterial pressure (p = 0.001) and increased cardiac output (p = 0.009), PaO2 (p = 0.035) and SaO2 (p = 0.015). 72% improved the functional class from III-IV to I-II. There was mortality of 20% associated to persistence of pulmonary arterial hypertension and the three-year survival was 80%. Two patients required ECMO A-V both successful. Conclusion: Thromboendarterectomy is the treatment of choice for patients with chronic pulmonary thromboembolism, significantly improving hemodynamic and functional parameters, reflected in their quality of life and survival.
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