胸腔镜下肺减容术治疗高海拔地区慢性阻塞性肺气肿肺动脉高压的临床研究

doi:10.12114/j.issn.1007-9572.2019.00.532

摘要/Abstract

摘要： 背景　高原地区空气干燥，是呼吸道疾病高发地区，同时高原地区氧含量低，又会加重呼吸心血管系统疾病。而肺气肿、肺大泡、肺动脉高压本身就对呼吸系统和心血管系统造成较大的影响。如果患者身处高原地区，其病理生理情况与低海拔地区有较大的不同，临床行肺减容术（LVRS）面对的问题和困难也有较大的差别。目的　探讨胸腔镜下LVRS治疗高海拔地区慢性阻塞性肺气肿肺动脉高压的临床疗效。方法　选择2009年9月—2016年12月甘肃省人民医院收治的56例慢性阻塞性肺气肿肺动脉高压患者，均行胸腔镜下LVRS，其中单侧LVRS 40例，双侧LVRS 16例。观察患者术后一般情况，比较患者术前、术后2周、术后2个月第1秒用力呼气末容积（FEV1）、肺动脉压、每搏输出量、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、登楼试验。以术后饮食、睡眠、平卧、胸闷气短、登楼试验的改善情况（以患者主观感受肯定或者否定）评定生活质量。结果　40例行单侧LVRS患者，2例半年内分期行双侧LVRS患者，14例同期行双侧 LVRS患者中2例死亡。术中切除每侧肺容积的20%~70%。其中术后2周、2个月FEV1、每搏输出量、PaO2及登楼试验均高于术前，肺动脉压、PaCO2均低于术前（P<0.05）。患者睡眠、登楼试验改善率由术后2周的60%左右升高到90%左右及以上，胸闷气短改善率由术后2周的75%左右升高到90%左右。结论　胸腔镜下LVRS能明显改善高海拔地区患者病情及生活质量，是适合经济欠发达的内陆高原地区治疗肺气肿肺动脉高压的治疗方法。

关键词: 肺气肿；高血压, 肺性；肺切除术；胸腔镜检查；高海拔地区

Abstract: Background　Air dryness in plateau area makes it a high-risk area of respiratory diseases.At the same time，the low oxygen content in plateau area aggravates respiratory and cardiovascular diseases.However，pulmonary emphysema，bullae，and hypertension have a great impact on the respiratory system and cardiovascular system.The pathophysiological process of patients with hypoxemia and pulmonary hypertension in plateau area is quite different from those in the low-altitude regions，and the problems and difficulties faced by lung volume reduction surgery（LVRS） are also quite different.Objective　To investigate the clinical efficacy of thoracoscopic LVRS in the treatment of chronic obstructive emphysema with pulmonary hypertension in high-altitude regions.Methods　A total of 56 patients with chronic obstructive emphysema with pulmonary hypertension treated with LVRS through thoracoscopic surgery or video-assisted minithoracotomy in Gansu Provincial Hospital from September 2009 to December 2016 were enrolled，including 40 cases of unilateral LVRS，and 16 cases of bilateral LVRS.Observing the general condition of the patients after treatment and comparing their forced expiratory volume in one second（FEV1），pulmonary artery pressure，stroke volume，partial pressure of oxygen（PaO2），arterial partial pressure of carbon dioxide（PaCO2），and stair climbing test before treatment，at two weeks and two months after treatment.The quality of life was assessed by the postoperative improvement of diet，sleep quality，supine，chest tightness and shortness of breath，and landing test（positive or negative subjective feelings）．Results　40 cases of unilateral LVRS，two patients underwent bilateral LVRS within six months later，and 14 cases underwent bilateral LVRS in the same period died.During the operation，20% to 70% of each side of the lung volume was resected.FEV1，stroke volume，PaO2 and stair climbing test at two weeks and two months after operation were higher than those before operation，pulmonary artery pressure，PaCO2 at two weeks and two months after operation were lower than those before operation（P<0.05）．The improvement rate of patients' sleep quality and stair climbing test increased from 60% to 90% and more in two weeks after operation，and the improvement rate of chest tightness and shortness of breath increased from 75% to 90% in two weeks after operation.Conclusion　LVRS at high altitude can significantly improve patient's condition and quality of life.It is safe and effective，and is suitable for the treatment of emphysema with pulmonary hypertension in the underdeveloped inland plateau area.

Key words: Pulmonary emphysema；Hypertension, pulmonary；Pneumonectomy；Thoracoscopy；High-altitude regions

梁忠,魏振宏,虎卫东,等. 胸腔镜下肺减容术治疗高海拔地区慢性阻塞性肺气肿肺动脉高压的临床研究[J]. 中国全科医学, 2019, 22(33): 4087-4090. DOI: 10.12114/j.issn.1007-9572.2019.00.532.
LIANG Zhong,WEI Zhenhong,HU Weidong, et al. Clinical Study on the Treatment of Pulmonary Hypertension in Pulmonary Emphysema with Video Assisted Thoracoscopic Lung Volume Reduction Surgery at High-altitude Regions　[J]. Chinese General Practice, 2019, 22(33): 4087-4090. DOI: 10.12114/j.issn.1007-9572.2019.00.532.

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