doi:10.3969/j.issn.1004-583X.2026.07.013

Abstract

CLC Number:

R541.5

Add to citation manager EndNote|Ris|BibTeX

URL: https://www.lchc.cn/EN/10.3969/j.issn.1004-583X.2026.07.013

https://www.lchc.cn/EN/Y2026/V41/I7/653

Figures/Tables 2

References 39

[1]	中华医学会呼吸病学分会肺栓塞与肺血管病学组, 中国医师协会呼吸医师分会肺栓塞与肺血管病工作组, 全国肺栓塞与肺血管病防治协作组, 等. 慢性血栓栓塞性肺动脉高压诊断与治疗指南(2024版)[J]. 中华医学杂志, 2024, 104(24): 2200-2221. doi:10.3760/cma.j.cn112137-20240116-00117.
[2]	Dubs L, Ulrich S, Lichtblau M, et al. Pulmonary endarterectomy and treatment for chronic thromboembolic pulmonary hypertension[J]. Praxis (Bern 1994), 2023, 112(1): 28-35. doi:10.1024/1661-8157/a003964.
[3]	刘晓鹏, 甄雅南. 慢性血栓栓塞性肺动脉高压的外科手术治疗[J]. 中国实用内科杂志, 2023, 43(1): 10-13, 27. doi:10.19538/j.nk2023010103.
[4]	Jenkins D, Madani M, Fadel E, et al. Pulmonary endarterectomy in the management of chronic thromboembolic pulmonary hypertension[J]. Eur Respir Rev, 2017, 26(143): 160111. doi:10.1183/16000617.0111-2016.
[5]	Yang J, Madani MM, Mahmud E, et al. Evaluation and management of chronic thromboembolic pulmonary hypertension[J]. Chest, 2023, 164(2): 490-502. doi:10.1016/j.chest.2023.03.029.
[6]	Ley L, Grimminger F, Richter M, et al. The early detection of pulmonary hypertension[J]. Dtsch Arztebl Int, 2023, 120(48): 823-830. doi:10.3238/arztebl.m2023.0222.
[7]	刘格婧, 李爱莉, 翟亚楠, 等. 慢性血栓栓塞性肺动脉高压患者左心室功能改变及肺动脉内膜剥脱术后恢复情况[J]. 中华超声影像学杂志, 2022, 31(3): 245-251. doi:10.3760/cma.j.cn131148-20210818-00570.
[8]	Kim NH, D’Armini AM, Delcroix M, et al. Chronic thromboembolic pulmonary disease[J]. Eur Respir J, 2024, 64(4): 2401294. doi:10.1183/13993003.01294-2024.
[9]	Cannon JE, Su L, Kiely DG, et al. Dynamic risk stratification of patient long-term outcome after pulmonary endarterectomy[J]. Circulation, 2016, 133(18): 1761-1771. doi:10.1161/CIRCULATIONAHA.115.019470. pmid: 27052413
[10]	Mcdonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure[J]. Eur Heart J, 2021, 42(36): 3599-3726. doi:10.1093/eurheartj/ehab368.
[11]	Kriechbaum SD, Birmes J, Wiedenroth CB, et al. Exercise MR-proANP unmasks latent right heart failure in CTEPH[J]. J Heart Lung Transplant, 2022, 41(12): 1819-1830. doi:10.1016/j.healun.2022.08.017.
[12]	He J, Fang W, Lv B, et al. Diagnosis of chronic thromboembolic pulmonary hypertension: Comparison of ventilation/perfusion scanning and multidetector computed tomography pulmonary angiography with pulmonary angiography[J]. Nucl Med Commun, 2012, 33(5): 459-463. doi:10.1097/MNM.0b013e32835085d9.
[13]	Currie GM, Bailey DL. V/Q SPECT and SPECT/CT in pulmonary embolism[J]. J Nucl Med Technol, 2023, 51(1): 9-15. doi:10.2967/jnmt.122.264880. pmid: 36599703
[14]	Ma J, Li C, Zhai Z, et al. Distribution of thrombus predicts severe reperfusion pulmonary edema after pulmonary endarterectomy[J]. Asian J Surg, 2023, 46(9): 3766-3772. doi:10.1016/j.asjsur.2023.03.061.
[15]	Masy M, Giordano J, Petyt G, et al. Dual-energy CT (DECT) lung perfusion in pulmonary hypertension: Concordance rate with V/Q scintigraphy in diagnosing chronic thromboembolic pulmonary hypertension (CTEPH)[J]. Eur Radiol, 2018, 28(12): 5100-5110. doi:10.1007/s00330-018-5467-2. pmid: 29846802
[16]	Duan J, Liu L, Guo S, et al. Evaluation of pulmonary perfusion and ventilation in suspected chronic thromboembolic pulmonary hypertension via phase-resolved functional lung magnetic resonance imaging: Correlations with hemodynamics and cardiopulmonary function[J]. Quant Imaging Med Surg, 2025, 15(8): 7169-7182. doi:10.21037/qims-2024-2750.
[17]	Afşin H, Afşin E, Coşgun Z. Comparison of ventilation/perfusion scintigraphy and pulmonary CT angiography: Findings in the diagnosis of CTEPH and CTED[J]. Hell J Nucl Med, 2024, 27(3): 188-197. doi:10.1967/s002449912753. pmid: 39644270
[18]	Kim NH, Delcroix M, Jais X, et al. Chronic thromboembolic pulmonary hypertension[J]. Eur Respir J, 2019, 53(1): 1801915. doi:10.1183/13993003.01915-2018.
[19]	Myllylahti L, Ropponen J, Lax M, et al. Upregulation of coagulation factor VIII and fibrinogen after pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension[J]. Clin Appl Thromb Hemost, 2023, 29: 10760296231158369. doi:10.1177/10760296231158369.
[20]	楼松, 闫姝洁, 朱家德, 等. 肺动脉内膜剥脱术体外循环管理经验[J]. 中国体外循环杂志, 2018, 16(4): 211-215. doi:10.13498/j.cnki.chin.j.ecc.2018.04.05.
[21]	Yildizeli SO, Arikan H, Güngör S, et al. Pulmonary endarterectomy: Risk factors for early and late mortality[J]. Thorac Cardiovasc Surg, 2025, 73(3): 230-236. doi:10.1055/a-2409-5944.
[22]	Kim KK, Krause M, Brandes IF, et al. Transesophageal echocardiography for perioperative management in thoracic surgery[J]. Curr Opin Anaesthesiol, 2021, 34(1): 7-12. doi:10.1097/ACO.0000000000000947. pmid: 33315644
[23]	周荟, 王伟鹏. 肺动脉内膜剥脱术患者的麻醉管理[J]. 临床麻醉学杂志, 2017, 33(3): 305-308. doi:10.3969/j.issn.1004-5805.2017.03.024.
[24]	Das S, Krithika KG. Anesthetic management of chronic thromboembolic pulmonary hypertension for surgical pulmonary thromboendarterectomy: A narrative review[J]. J Anaesthesiol Clin Pharmacol, 2025, 41(3): 418-426. doi:10.4103/joacp.joacp_362_24. pmid: 40635829
[25]	Anonymous. Perioperative management of pulmonary endarterectomy-perspective from the UK national health service[J]. J Cardiothorac Vasc Anesth, 2019, 33(11): 3101-3109. doi:10.1053/j.jvca.2018.11.033. pmid: 30686656
[26]	Anonymous. Evaluation of the clinical utility of transesophageal echocardiography and invasive monitoring to assess right ventricular function during and after pulmonary endarterectomy[J]. J Cardiothorac Vasc Anesth, 2018, 32(2): 771-778. doi:10.1053/j.jvca.2017.09.026. pmid: 29310938
[27]	张亚军. 慢性血栓栓塞性肺动脉高压患者的麻醉管理[J]. 中国实用内科杂志, 2023, 43(1): 14-19. doi:10.19538/j.nk2023010104.
[28]	Liu Z, Liu X, Lin F, et al. Duration of regional cerebral oxygen saturation under 40% is a risk factor for neurological injury following pulmonary thromboendarterectomy: A prospective observational study[J]. J Card Surg, 2022, 37(9): 2610-2617. doi:10.1111/jocs.16615.
[29]	Ishida K, Kohno H, Matsuura K, et al. Modification of pulmonary endarterectomy to prevent neurologic adverse events[J]. Surg Today, 2023, 53(3): 369-378. doi:10.1007/s00595-022-02573-w.
[30]	甄雅南, 刘晓鹏, 林凡, 等. 肺动脉血栓内膜剥脱术脑保护策略及效果[J]. 中华医学杂志, 2019, 99(37): 2916-2920. doi:10.3760/cma.j.issn.0376-2491.2019.37.009.
[31]	Diop S, Nader M, Fadel E, et al. Acid-base status of the blood contained in the cardiotomy reservoir during deep hypothermic circulatory arrest at 18 ℃[J]. J Extra Corpor Technol, 2025, 57(3): 123-128. doi:10.1051/ject/2025014.
[32]	Chatzopoulou G, Voucharas C, Kougkouli I, et al. Comparison of clinical outcomes between alpha-stat and ph-stat strategies during hypothermic circulatory arrest: A systematic review[J]. Cureus, 2025, 17(7): e87279. doi:10.7759/cureus.87279.
[33]	Ramírez-Ramos CF, Saldarriaga-Giraldo CI, Yepes-Calderón M, et al. Arterial lactate levels and their prognostic value in patients undergoing pulmonary thromboendarterectomy[J]. Arch Peru Cardiol Cir Cardiovasc, 2021, 2(2): 96-102. doi:10.47487/apcyccv.v2i2.131.
[34]	方颖慧, 张亚军, 甄雅南, 等. 深低温停循环下肺动脉内膜剥脱术中患者血乳酸升高的相关因素及其对预后的影响[J]. 中华医学杂志, 2023, 103(2): 125-131. doi:10.3760/cma.j.cn112137-20220725-01614.
[35]	马军宇, 段军. 肺动脉内膜剥脱术术后重症监护和管理[J]. 中国实用内科杂志, 2023, 43(1): 1-4, 9. doi:10.19538/j.nk2023010101.
[36]	Skoro-Sajer N, Marta G, Gerges C, et al. Surgical specimens, haemodynamics and long-term outcomes after pulmonary endarterectomy[J]. Thorax, 2014, 69(2): 116-122. doi:10.1136/thoraxjnl-2013-203746. pmid: 24052543
[37]	Yilmazel uçar E, Donkar B, Araz Ö, et al. A massive pulmonary thromboembolism after pulmonary endarterectomy: A case report[J]. Tuberk Toraks, 2020, 68(1): 76-79. doi:10.5578/tt.69183. pmid: 32718142
[38]	宋武, 刘盛. 慢性血栓栓塞性肺动脉高压的抗凝治疗进展[J]. 中国循证心血管医学杂志, 2021, 13(3): 377-379. doi:10.3969/j.issn.1674-4055.2021.03.30.
[39]	蔡秋燕, 刘旺林, 程卫, 等. 床旁高渗盐水造影肺灌注电阻抗断层成像技术在肺动脉内膜剥脱术后应用2例并文献复习[J]. 协和医学杂志, 2025, 16(2): 513-518. doi:10.12290/xhyxzz.2024-0222.

阶段	监测系统	核心监测项目	关键阈值/目标值	主要临床意义
术前	循环系统	超声心动图(TRV、LVGLS)	TRV>2.8 m/s提示肺动脉高压;LVGLS下降提示高危	评估右心功能,预警术后左心衰竭
		右心导管(PVR)	PVR>1 200 dyn·s·cm^-5提示高风险	确诊CTEPH,风险分层
		生物标志物(NT-proBNP)	升高提示右心失代偿	识别右心衰竭
	呼吸系统	CTPA、V/Q扫描	CTPA见壁状血栓	筛查与确诊CTEPH
	凝血系统	FⅧ、血小板、PT/APTT	FⅧ升高提示肝素耐药	指导抗凝方案
	功能状态	6MWT	距离缩短提示预后不良	评估心肺储备
术中	心脏功能	TEE	实时监测右心室功能	指导导管放置,评估手术效果
	脑功能	rSO₂、BIS	rSO₂<40%为停循环阈值;BIS降至0	预警脑缺氧,减少神经并发症
	血压	有创动脉压(股动脉)	维持平均动脉压稳定	低温下桡动脉压不准,指导用药
	温度	鼻咽温、膀胱温	降温复温梯度<0.5 ℃/min;温差<5 ℃	均匀脑保护
	血气	乳酸、PaO₂/PaCO₂	乳酸<7 mmol/L;允许性高碳酸血症	预警低灌注,保护脑循环
术后	循环系统	肺动脉导管(PVR、心脏指数)、有创动脉压	PEA后PVR下降;维持心脏指数≥2.5 L·min^-1·m^-2	评估手术效果,指导正性肌力药
		凝血(APTT、INR)	APTT 1.5~2.倍,INR 2~3	预防出血与血栓
		液体平衡	24 h负平衡,尿量>0.5 ml/(kg.h)	减少再灌注损伤
	呼吸系统	氧合指数、气道压、PEEP	PEEP 5~10 cmH₂O,FiO₂≤0.4	预警再灌注肺水肿,指导脱机

阶段	监测系统	核心监测项目	关键阈值/目标值	主要临床意义
术前	循环系统	超声心动图(TRV、LVGLS)	TRV>2.8 m/s提示肺动脉高压;LVGLS下降提示高危	评估右心功能,预警术后左心衰竭
		右心导管(PVR)	PVR>1 200 dyn·s·cm^-5提示高风险	确诊CTEPH,风险分层
		生物标志物(NT-proBNP)	升高提示右心失代偿	识别右心衰竭
	呼吸系统	CTPA、V/Q扫描	CTPA见壁状血栓	筛查与确诊CTEPH
	凝血系统	FⅧ、血小板、PT/APTT	FⅧ升高提示肝素耐药	指导抗凝方案
	功能状态	6MWT	距离缩短提示预后不良	评估心肺储备
术中	心脏功能	TEE	实时监测右心室功能	指导导管放置,评估手术效果
	脑功能	rSO₂、BIS	rSO₂<40%为停循环阈值;BIS降至0	预警脑缺氧,减少神经并发症
	血压	有创动脉压(股动脉)	维持平均动脉压稳定	低温下桡动脉压不准,指导用药
	温度	鼻咽温、膀胱温	降温复温梯度<0.5 ℃/min;温差<5 ℃	均匀脑保护
	血气	乳酸、PaO₂/PaCO₂	乳酸<7 mmol/L;允许性高碳酸血症	预警低灌注,保护脑循环
术后	循环系统	肺动脉导管(PVR、心脏指数)、有创动脉压	PEA后PVR下降;维持心脏指数≥2.5 L·min^-1·m^-2	评估手术效果,指导正性肌力药
		凝血(APTT、INR)	APTT 1.5~2.倍,INR 2~3	预防出血与血栓
		液体平衡	24 h负平衡,尿量>0.5 ml/(kg.h)	减少再灌注损伤
	呼吸系统	氧合指数、气道压、PEEP	PEEP 5~10 cmH₂O,FiO₂≤0.4	预警再灌注肺水肿,指导脱机

并发症类型	典型表现	关键监测指标	预警阈值
再灌注肺水肿	低氧、肺顺应性下降、咯血	氧合指数、气道峰压、EIT、胸部影像	氧合指数<200 mmHg;气道压骤升
右心衰竭/循环不稳定	低血压、低心排血量、颈静脉怒张	CVP、PVR、心指数、乳酸、TEE	乳酸≥7 mmol/L;PVR下降不足
神经系统并发症	术后认知障碍、卒中、意识延迟恢复	rSO₂、BIS、脑电图、体温梯度	rSO₂<40%持续时间过长;BIS异常
出血/凝血障碍	胸引量增多、气道出血、瘀斑	血小板、PT、APTT、血栓弹力图、FⅧ	APTT异常延长;FⅧ显著升高
肺不张/低通气	低氧、高碳酸血症	潮气量、PEEP、呼吸频率、EIT	FiO₂>0.5仍低氧、气道压升高

并发症类型	典型表现	关键监测指标	预警阈值
再灌注肺水肿	低氧、肺顺应性下降、咯血	氧合指数、气道峰压、EIT、胸部影像	氧合指数<200 mmHg;气道压骤升
右心衰竭/循环不稳定	低血压、低心排血量、颈静脉怒张	CVP、PVR、心指数、乳酸、TEE	乳酸≥7 mmol/L;PVR下降不足
神经系统并发症	术后认知障碍、卒中、意识延迟恢复	rSO₂、BIS、脑电图、体温梯度	rSO₂<40%持续时间过长;BIS异常
出血/凝血障碍	胸引量增多、气道出血、瘀斑	血小板、PT、APTT、血栓弹力图、FⅧ	APTT异常延长;FⅧ显著升高
肺不张/低通气	低氧、高碳酸血症	潮气量、PEEP、呼吸频率、EIT	FiO₂>0.5仍低氧、气道压升高

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 2

References 39

Related Articles 15

Recommended Articles

Metrics

Comments

[1]	. [J]. Clinical Focus, 2025, 40(11): 1043-1046.
[2]	. [J]. Clinical Focus, 2025, 40(3): 275-280.
[3]	. [J]. Clinical Focus, 2024, 39(2): 188-192.
[4]	. [J]. Clinical Focus, 2023, 38(9): 838-844.
[5]	Wei Qingyuan, Yin Xufang, Li Jiaojiao. Application of BNP, Hcy, AVP, CPT in disease development and efficacy evaluation of patients with chronic pulmonary heart disease [J]. Clinical Focus, 2021, 36(7): 600-603.
[6]	. [J]. CLINICAL FOCUS, 2013, 28(10): 1164-1166.
[7]	. [J]. Clinical Focus, 2012, 27(18): 1624-1626.
[8]	. [J]. CLINICAL FOCUS, 2011, 26(19): 1730-1732.
[9]	. [J]. CLINICAL FOCUS, 2010, 25(1): 68-69.
[10]	ZHANG Yu-qing;ZHANG Xiu-wei;ZHU Ying;YANG Jian. Effect of atorvastatin on right ventricular function in chronic obstructive pulmonary disease patients with chronic cor pulmonale [J]. CLINICAL FOCUS, 2009, 24(22): 1933-1936.
[11]	ZHU Yan-hui;SONG Qiao-feng;WANG Xi-zhu;JIA Hong-juan;LIU Chun-rong;YAO Yan-min;DONG Yan. Different doses of atorvastatin on serum lipids, big-endothelines,brain natriuretic peptide and pulmonary artery pressure in hyperlipidemic patients with chronic cor pulmonale [J]. CLINICAL FOCUS, 2009, 24(7): 567-570.
[12]	. [J]. CLINICAL FOCUS, 2009, 24(3): 248-249.
[13]	. [J]. CLINICAL FOCUS, 2008, 23(7): 490-491.
[14]	. [J]. CLINICAL FOCUS, 2008, 23(3): 184-185.
[15]	. [J]. CLINICAL FOCUS, 2007, 22(23): 1697-1697.