Oxygen inhalation can selectively dilate pulmonary arteries in patients with chronic thromboembolic pulmonary hypertension before balloon angioplasty
Oxygen inhalation can selectively dilate pulmonary arteries in patients with chronic thromboembolic pulmonary hypertension before balloon angioplasty
复制标题
慢性血栓栓塞性肺动脉高压患者球囊成形术前吸氧可选择性扩张肺动脉
DOI：
10.1016/j.jjcc.2021.09.003
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发表时间：
2022
影响因子：
2.5
通讯作者：
Matsubara Hiromi
中科院分区：
文献类型：
--
作者：
Shigetoshi Masataka;Hatanaka Kunihiko;Ogawa Aiko;Tabuchi Isao;Shimokawahara Hiroto;Munemasa Mitsuru;Ito Hiroshi;Matsubara Hiromi
肺损伤是球囊肺动脉成形术（BPA）治疗慢性血栓栓塞性肺动脉高压（CTEPH）的主要并发症。高平均肺动脉压（PAP）可加重BPA后的肺损伤。虽然吸氧，预计降低平均PAP在CTEPH患者，没有相关的调查已经centered. MethodsConcreative患者CTEPH谁接受BPA参加了这项研究。我们评估了使用右心导管的血流动力学，同时呼吸环境空气和管理的5 L/min的氧气10 min。ResultsThis研究包括52例连续CTEPH患者，其中23例（44%）与特定的肺血管扩张剂治疗。暴露于氧气的耐受性良好。吸氧显著降低了平均PAP 3.8 ± 3.2 mmHg（p<0.001）和肺血管阻力0.8 ± 1.8 Wood单位（p<0.001）。肺血管阻力与体循环阻力的比值显著降低13.5%（P<0.001）。多变量回归分析表明，基线平均PAP（β =-0.427，p = 0.006）是吸氧时平均PAP降低的唯一显著预测因素。在使用和不使用血管扩张剂的患者之间，氧气对平均PAP的影响无显著差异。结论在CTEPH患者中，无论使用何种血管扩张剂，5 L/min辅助吸氧均可通过选择性肺动脉扩张显著降低平均PAP，从而有助于最大限度地提高BPA的安全性。UMIN000026882）; URL：https://www.umin.ac.jp/ctr/index.htm.
BackgroundPulmonary injury is a major complication of balloon pulmonary angioplasty (BPA) for chronic thromboembolic pulmonary hypertension (CTEPH). Lung injury after BPA can be exacerbated by a high mean pulmonary arterial pressure (PAP). Although oxygen inhalation is expected to lower mean PAP in patients with CTEPH, no relevant investigation has been conducted.MethodsConsecutive patients with CTEPH who underwent BPA were enrolled in this study. We evaluated the hemodynamics using right heart catheterization while breathing ambient air and with administration of 5 L/min oxygen for 10 min.ResultsThis study included 52 consecutive patients with CTEPH, of whom 23 (44%) were treated with specific pulmonary vasodilators. Exposure to oxygen was well tolerated. Oxygen administration significantly decreased mean PAP by 3.8 ± 3.2 mmHg (p<0.001) and pulmonary vascular resistance by 0.8 ± 1.8 Wood units (p<0.001). Moreover, the ratio of pulmonary vascular resistance to systemic vascular resistance was significantly reduced by 13.5% (p<0.001). Multivariate regression analysis identified baseline mean PAP (β = -0.427,p= 0.006) as the only significant predictor of decreased mean PAP under oxygen administration. No significant difference in oxygen effect on mean PAP was found between patients with and without vasodilators.ConclusionsIn patients with CTEPH, 5 L/min supplemental oxygen inhalation could decrease mean PAP significantly by selective pulmonary artery dilatation, regardless of the usage of vasodilators, and thus could be helpful to maximize the safety of BPA.Clinical trial registrationUMIN Clinical Trials Registry (No.: UMIN000026882); URL: https://www.umin.ac.jp/ctr/index.htm.