論文No1928
Safety of diagnostic flexible bronchoscopy in patients with echocardiographic evidence of pulmonary hypertension
Tsukasa Ishiwata, Mitsuhiro Abe, Hajime Kasai, Jun Ikari, ... Koichiro Tatsumi
Respiratory Investigation, Volume 57, Issue 1, January 2019, Pages 73-78
＜背景＞
肺高血圧症(PH)の存在と抗凝固療法は気管支鏡手技に関連した
出血／血行動態的合併症を潜在的に増加させるかもしれない。
この研究の目的はPH患者における診断的軟性気管支鏡(FB)の際の安全性を評価することである。
＜方法＞
心エコーでPH(右室収縮期圧[RVSP] > 40mmHg)の所見があり
2004年から2016年に診断的FBを行った患者のカルテを日本の一施設で後ろ向きに検討した。
同じ時期にPHを思わせる所見がなくてFBを行った患者をペアマッチのコントロール患者とし、年齢、性別、検査手技でマッチさせた。
＜結果＞
全体で45名のPH患者、90名のコントロール患者となった。
PH群6名(13%)は重症のPH(RVSP > 61 mmHg)であった。
PH群では鉗子による生検62%、経気管支針生検13%が行われ、コントロール群では58%, 13%に行われた。
FBの際の出血の頻度はFBとコントロール群とで差がなかった(18% versus 16%; p = 0.742)。
FB後２時間後のバイタルサインも両群で差がなかった。
FBの手技に関連した心臓不整脈や死亡はなかった。
＜感想＞
PH患者であっても軟性気管支鏡は安全に施行できたようです。
Background
The presence of pulmonary hypertension (PH) and treatment with anticoagulant agents could potentially increase the risk for bleeding/hemodynamic complications associated with bronchoscopic procedures. The aim of this study was to assess the safety of diagnostic flexible bronchoscopy (FB) in patients with PH.
Methods
A retrospective review of clinical records of patients with echocardiographic evidence of PH (right ventricular systolic pressure [RVSP] > 40 mm Hg) who underwent diagnostic FB between 2004 and 2016 at a single facility in Japan was conducted. Patients with no clinical evidence suggestive of PH who underwent FB during the same period were enrolled as a pairwise-matched control group; factors used in matching included age, sex, and performed procedures.
Results
Overall, there were 45 patients in the PH group and 90 patients in the control group. Six (13%) patients in the PH group had severe PH (RVSP > 61 mm Hg). Forceps biopsies and transbronchial needle aspirations were performed in 62% and 13% of patients, respectively, in the PH group, and 58% and 13% of patients, respectively, in the control group. The total incidence of bleeding during FB was not significantly different between the two groups (18% versus 16%; p = 0.742). Vital signs recorded 2 h after FB were also not significantly different between the two groups. There were no episodes of cardiac arrhythmias or deaths associated with the FB procedures.
Conclusions
The data suggest that diagnostic FB procedures can be performed safely in patients with echocardiographic evidence of PH.