[慢性血栓栓塞性肺高血压的管理更新]
Jesús Ribas Sola1, Miguel Ángel Sánchez-Corral Mena2, Antoni Riera-Mestre3
1Unidad de Enfermedades Vasculares Pulmonares, Servicio de Neumología, Hospital Universitari de Bellvitge, Barcelona, España; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, España.
慢性血栓栓塞性肺高血压 (CTEPH) 是肺栓塞 (PE) 后可治愈的疾病. 诊断包括成像和右心脏导管,治疗包括手术,血管整形和药物治疗以改善结果.
科学领域:
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
- 血管医学 血管医学
背景情况:
- 慢性血栓栓塞性肺高血压 (CTEPH) 由未解决的肺栓塞 (PE) 引起,导致肺动脉阻塞和毛囊前肺高血压 (PH).
- 远距离微血管病变可以加剧肺血管抵抗在CTEPH患者.
- 早期的怀疑和诊断对于有效的管理至关重要.
研究的目的:
- 要概述CTEPH的诊断途径.
- 描述CTEPH目前的治疗策略.
- 强调CTEPH管理中的多式联运方法.
主要方法:
- 诊断工具包括用于怀疑PH的跨胸腔心声学,用于诊断确认的通风 perfusion 肺部光阴学,以及用于最终评估的右心导管.
- 肺血管造影用于评估血栓栓塞性病变的程度和手术切除能力.
- 对于CTEPH的定义,需要在3个月的抗凝药后出现症状, perfusion 缺陷和 precapillary PH.
主要成果:
- 肺内关节切除术是主要的治疗方法,具有显著的临床和血液动力学益处.
- 大约25%的患者在手术后出现残留PH.
- 气球肺血管整形和药理疗法对于不可手术的病例或术后残留PH的治疗至关重要.
结论:
- CTEPH是一种具有结构化的诊断和治疗方法的潜在可治愈的疾病.
- 结合肺内关节切除术,气球肺血管整形术和药物治疗的多式策略对于最佳的CTEPH管理至关重要.
- 长期抗凝药是CTEPH护理的标准组成部分.
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