老年渔民肺肿瘤患者术后心肺功能变化的临床研究

目的 研究老年渔民肺肿瘤肺切除患者在静息及运动负荷状态下手术前后的心肺功能变化规律,为放宽老年肺肿瘤患者手术指征提供依据.方法 41例因患肺肿瘤行肺叶切除术的患者分为老年组24例(≥60岁)、中青年组17例(<60岁),分别于术前3～5 d和术后3～6个月在患者日常生活无障碍时,采用心肺功能仪和多普勒超声技术在静息及运动负荷状态下测定心肺功能,指标包括心率(HR)、左心室舒张末期容积(LVEDV)、每搏量(SV)、心输出量(CO)、左心室射血分数(LVEF)、呼吸频率(RR)、潮气量(VT)、每分通气量(VE)和氧摄取量(VO2),并对其结果进行分析比较.结果 所有患者在静息和运动负荷状态下心功能参数LVEDD和SV术后较术前均有明显降低(P<0.01),静息状态下HR、RR、VT手术前后比较差异有统计学意义(P<0.05或P<0.01).进行年龄分组后,两组在静息状态下术后SV、VT均减小,CO、VE、VO2手术前后差异有统计学意义(P<0.01);运动负荷状态下术后两组VO2均减少,但老年组VE减少明显(P<0.01).结论 肺切除术后静息状态时CO和VE分别通过HR和RR的增加得到补偿,保证了氧摄取量,而术后运动负荷状态下CO和VE的减少不能通过HR和RR得到代偿,老年组VO2降低主要是VE减少所致,而中青年组则是由CO减少所致.

Clinical investigation of cardiopulmonary function changes after pulmonary resection in old patients with lung tumor

Objective To investigate the cardiopulmonary function in the old patients with lung tumor resection at rest and during maximum exercise by echocardiography. And provide more suitable operation-index for lung tumor. Methods A total of 41 patients with lung tumor who had undergone lung resection were divided into two groups: the elder patients group ( ≥60 years) containing 24 cases while the middle-younger patients group ( < 60 years) containing 17 cases. When they behaved themselves normally in their daily lives, the cardiopulmonary function were monitored by cardiopulmonary functional instrument and echocardiography from 3～5 days preoperatively and 3～6 months postoperatively. Heart rate ( HR) , left ventricular end - diastolic volume (LVEDV), stroke volume (SV) , cardiac output (CO), Left ventricular ejection fraction (LVEF), respiration rale (RR) , tidal volume (VT) , minute ventilation (VE) , and oxygen consumption (VO(2) ) were observed and analyzed. Results Levels of LVEDV and SV were decreased after operation both at rest and undermovement (P<0.01). The were statistical significance of HR, RR, VT at rest and RR, VT, VE, VO(2), CO during movement before and after operation (P<0. 05 or P<0.01). After being divided into two groups, SV and VT afteroperation were decreased in both groups at restwhile. CO, VE and VO(2) showed statistical siginificance before and after operation. VO(2) was decreased in both groups postoperatively undermovement. VE was decreased in the elder patients group. Conclusions At rest, contents of CO and VE after operation were preserved by the increment of HR and RR, the decrement of CO and VE were not compensated by HR and RR. In older patients group, postoperative decrease of VO(2) was mainly due to VE decreasing while inmiddle-younger patients group, it was due to CO lowering.