超声评估右室功能对肺切除术的临床意义

目的:用超声心动图观察肺切除围术期右心功能的改变,探讨肺切除手术对右心功能的影响机制,右心功能的改变与术后心脏并发症的依存关系,以证实超声心动图测定右心功能作为评估肺切除术危险性的有效性。方法:对94例患者在行肺切除的手术前 1~3d,术后 7~10d、80~90d,进行彩色多普勒超声心动图检测,据心尖四腔心的双平面 Simpson公式,测算右室射血分数,评估右室收缩功能;组织多普勒观察三尖瓣环运动,脉冲多普勒测量三尖瓣口血流 E/A,评估右室的舒张功能。观察分析右室收缩功能和右室舒张功能指标与术后并发症的发生率的差异。结果:肺切除术可使右心功能减退,有并发症组术前RVEF较无并发症组显著降低。且并发症的发生率随术前 RVEF的降低而升高,尤以RVEF<40%明显。结论:术前超声测定右室收缩功能指标 RVEF可作为评价肺切除术危险性的有效指标之一,而三尖瓣口血流E/A,三尖瓣环室壁运动EW/AW作为评估右室舒张功能的指标可以作为评价肺切除术危险性的参考值。

The Clinical Value of Assessment of Right Ventricular Performance after Pulmonary Resection with Ultrasonic

Objective: To prove the value of the risk factors of pulmonary resection with right ventricular performance detecting by ultrasonic. We observed the changes of right ventricular by ultrasonic ECG in perioperation of pulmonary resection . and then find out the related factors of right ventricular performance with pulmonary resection, the complications after operation with the change of right ventricular performance.Method: We detected 94 cases with ultrasonic ECG before the operation 1~3 days ,7~10 days and 80~90 days , and then assess contractile and diastolic in right ventricular performance according to the related index. respectively to draw the relation of complication after operation with the index of right ventricular diastolic and contractile. Result: Pulmonary resection can letdown the right ventricular performance. The RVEF before operation in complication group decreased significantly than that in without complication group. Morever , The RVEF before operation are lower, the rate of the complications are higher, esp.those RVEF<40% are obvious. Conclusion:The RVEF detected by ultrasonic is one of the main index to assess the risk factors of pulmonary resection. The E/A in tricuspid blood stream EW/AW performance in tricuspid for right ventricular diastolic are the second reasons to assess the risk for pulmonary resection.