肺叶切除术对心肌血供及血流动力学的影响

研究肺手术对心肌血供及血流动力学的影响。杂种犬18只，随机分为A、B、C3组。A、C组首先建立冠状动脉狭窄模型。1周后处死C组犬，观察心肌超微结构；A、B组分别行右上肺叶切除术，观察手术前后血常规、血气分析、心电图、心肌核素、血流动力学及心肌病理改变。结果显示，肺叶切除术可导致和加重心肌缺血；PO2及SaO2下降；CI下降（P＜0．01），MPAP、PCWPey LVEDP增高（P＜0．05；P＜0．01；P＜0．01）；A组LVEDP较B组明显增高，CI较B组下降。提示，肺叶切除术可导致心肌缺血及血流动力学障碍，冠脉狭窄者危险性更大，手术使血PO2及SaO2下降是导致血流动力学障碍的直接原因。

EXPERIMENTAL STUDY OF MYOCARDIAL ISCHEMIA AND HEMODYNAMIC CHANGES DURING PULMONARY LOBECTOMY IN DOG WITH OR WITHOUT CORONARY ARTERY STENOSIS

To determine the effect of pulmonary lobectomy on myocardial blood supply and hemodynamics, 18 dogs were randomized into 3 groups. The dogs in group A and C were subjected to about 75% occlusion of the left anterior descending coronary artery. One week later, dogs in group C were sacrificed by arterial bleeding, while dogs in group A and B underwent right upper pulmonary lobectomy, and extremity ECG, blood routine, blood gas, hemodynamics and morphological changes of the myocardium were examined. The results showed that pulmonary lobectomy could result in or worsen myocardial ischemia. There was significant decrease in PO 2 , SaO 2 ; and CI, and significant elevation of LVEDP, PCWP and MPAP. There were more elevation of LVEDP and less decrease in CI after lobectomy in group A compared with group B. It suggested that pulmonary lobectomy could intensify myocardial ischemi and indace hemodynamic disturbances by lowering PO 2 and SaO 2 , especially where there was coronary artery stenosis before the operation.