肺切除术影响围手术期右心功能

目的 检测肺切除术后围手术期右心功能指标的变化,以指导临床治疗.方法 将肺切除病人45例分为肺楔形切除组(Ⅰ组,10例)、单肺叶切除组(Ⅱ组,19例)、双肺叶切除组(Ⅲ组,7例)及全肺切除组(Ⅳ组,9例).通过中心静脉压(CVP)测定、脉冲多普勒血流频谱及组织多普勒技术了解术前、术后5-7d、术后1个月的右心室前、后负荷及泵功能变化.结果 与术前相比,各种术式术后5～7d中心静脉压均无明显变化;Ⅰ组术后右心后负荷、泵功能较术前无明显改变;Ⅱ组、Ⅲ组及Ⅳ组术后5～7d右心后负荷增加,右心泵功能下降,Ⅳ组更为明显;术后1个月,Ⅱ组右心后负荷、泵功能恢复到术前水平,但Ⅲ组及Ⅳ组与术前相比仍有异常.结论 肺切除术后存在不同程度的右心功能下降.

Effects of pulmonary resection on perioperative right ventricular function

Objective To investigate the changes of perioperative right ventricular function after pulmonary resction. Methods 45 cases of pulmonary resection were divided into four groups.Group Ⅰwas wedge resection(n = 10), GroupⅡ was lobectomy(n = 19), Group Ⅲ was double lobectomy(n=7)and Group Ⅳ was pneumonectomy(n=9). The changes of CVP, PAMP, PEP/ET, Sa, VTIs, RVSP, Ea/Aa, and Tel were evaluated by traditional ultrasonic and tissue Doppler ultrasonic techniques at different time inter- vals (pre-operation, 5-7 days orland 1 month post-operation), Results Compared with the pre-operation CVP, the indexes of all groups have no significant changes post-operatively. Wedge resection didn' t obviously influence right cardiac after load and systolic function/diastolic function. No evidet changes detected in Tei pre-and post-operatively. However, the indexes (PAMP, RVSP and PEP/ET ratio) reflecting right cardiac afterload evidently increased at post-pneumonectomy or lobectomy group5- 7 days post-opera- tive. All these reflect the decrease of Tei, which was more obvious in pneumonectomy than in lobectomy group. Right cardiac after- load, systolic/diastolic function and Tel index recovered to pre-operative level 1 month post-operation in single lobectomy group. But the above indicators, especially the Tel, were still high in double lobectomy and pmeunonectomy groups 1 morth post-operation.Tei index is positively correlated with PAMP and is weakly correlated with PET/ET ratio and Ea/Aa ratio. Conclusion Pulmonary wedge resection doesn't evidently influence right cardiac function. However, right cardiac diastolic function evidently decreases temporarily at lobectomy group. The systolic function and diastolic funetions decrease after double-lobectomy and pneumonectomy and it's more evident in pneumonectomy group. Though the right cardiac afterloads of lobectomy, double lobectomy and pneumonectomy groupa all increase significantly post-operativlye, only the former recover to pre-operative level 1 month after surgery.