超声心动图评价肺切除术后早期心功能变化

Color Doppler echocardiography for the evaluation of early cardiac function change after pneumonectomy

目的探讨老年肺癌患者肺切除术后的早期心功能变化。方法对33例老年肺癌患者在肺切除术前3d和术后4d分别行心脏超声心动图检查和动脉血气分析,检测左心室舒张末容积(LVEDV)、左心室每博量(LVSV)、心输出量(CO)、左心室射血分数(LVEF)、右心室舒张末容积(RVEDV)和右心室射血分数(RVEF),并检测肺动脉干收缩期血流流速曲线及肺动脉血流加速时间(AT),计算平均肺动脉压(mPAP)及肺血管阻力(PVR),以上参数均取3～5个心动周期的平均值,并对手术前后检测结果进行比较分析。结果术后患者心率(HR)增快,左心血流动力学参数LVEDV及LVSV较术前减小(P＜0.05),CO及LVEF术后与术前比较差异无统计学意义(P＞0.05)；右心血流动力学参数动脉血氧分压(PaO_2)及RVEF较术前下降(P＜0.05),而mPAP、RVEDV及PVR较术前升高(P＜0.05)。结论老年肺癌患者肺切除术后早期肺氧合功能减退,右心室功能减退,mPAP、RVEDV及PVR增高使左心室功能得到代偿。

Objective To investigate the early changes of cardiac function after pulmonary resection in elderly patients with lung cancer by eehocardiography and to clarify the mechanism of the occurrence of cardiac complications. Methods Thirty-three elderly patients with lung cancer were examined by Doppler eehocardiography and artery blood gas analysis 3 days before pulmonary resection and 4 days following the operation. Hemodynamie parameters, including left ventrieular end diastolic volume （LVEDV）, left ventric ular stroke volume （LVSV）, cardiac output （CO）, left ventrieular ejection fraction （LVEF）, right ventrieular end diastolic volume （RVEDV） and right ventrieular ejection fraction （RVEF） were measured. The blood flow velocity of systolic period of the pulmonary trunk was measured and a curve of it was made. The acceleration time （AT） of the pulmonary artery, the mean pulmonary artery pressure （mPAP） and pulmonary vessel resistance （PVR） were calculated. For all these parameters, the mean values were taken based on 3 to 5 cardiac cycles; and the preoperative values and postoperative ones were compared. Results Postoperatively, the heart rate of the patients increased and the LVEDV and LVSV decreased compare with those before operation （P 〈 0.05 ）. There was no significant difference in CO and LVEF between pre- and postoperation （P 〉 0.05 ）. However, the patients had lower PaO2 and RVEF （P 〈 0.05 ）, and higher mPAP, RVEDV and PVR （P 〈 0.05 ）, compared with those before preoperation. Conclusions The pulmonary oxygenation and right ventrieular function decline, while the mPAP, PVR and RVEDV increase in early stage after pulmonary resection in elderly patients with lung cancer, as a result, the left ventrieular function can be compensated.