肺减容术治疗重度慢性阻塞性肺气肿临床疗效分析

Clinical Analysis of Lung Volume Reduction Surgery in Patient with Chronic Obstructive Pulmonary Disease

目的:探讨肺减容手术(LVRS)治疗重度慢性阻塞性肺气肿病人(COPD)术后早期肺功能及肺血流动力学的变化。方法:64例重度COPD病人行LVRS手术,双侧19例、单侧45例。术前、术后3,6个月分别测量动脉血气(PaO_2、PaCO_2)、心脏超声多普勒检查(CO、CA、FS、EF、PAP)、肺功能(FEV1、RV、TLC)、6分钟运动试验(6-MWD),并对其结果进行比较分析。结果:61例患者临床症状改善,3例死亡;单侧LVRS术后3、6个月的FEV1较术前有明显提高(P<0.01),双侧LVRS术后各项指标改善较单侧更好(P<0.05),RV、TLC较术前有明显降低(P<0.01);术后PaO_2比术前提高(P<0.05),PaCO_2,较术前显著减低(P<0.05);肺血流动力学(CO、CI、EF、PAP)无明显变化(P>0.05)。结论:LVRS切除肺靶区20%～30%治疗重度COPD有效,术后早期肺功能明显改善、PaO_2提高、PaCO_2降低,而对心功能、肺动脉压力无明显负影响。

Objectlve：To investigate the early change of postoperative lung function and pulmonary hemedynamics of lung volume reduction surgery （ LVRS ） in patients with chronic obstrutive pulmonary disease. Methods： 64 patients with severe COPD were underwent LVRS, bilateral LVRS for 19 and unitateral LVRS in 45. The results of arterial blood gas analysis ,cardiac ultrasonic Doppler detection ,6 - rain walk distance （ 6MWD ） were analyzed before and 3,6 month after LVRS. Results： 61 patients get better and had better exercise capacity, 3 patients died. FEVI was improved significantly in 3,6month afer unilateral LVRS （ P 〈 0. 01 ）. All postoperative target of bilateral LVRS are better than that of unilateral LVRS （ P 〈0. 05 ）. RV, TLC, PaO2, PaCO2 were improved significantly （all P 〈 0. 05 ）, but there was no statistic difference in pulmonary hemedynamics. Conclusion： LVRS can result in benefits, with a goal of resecting 20% to 30% of each lung. LVRS can improve significantly lung ruction and PaO2, reduce PaCO2 ,and have no negative effect to cardiac function and pulmonary arterial pressure.