超声监测肺减容术后早期右心功能

Study of right ventricular function by echocardiography after lung volume reduction surgery

目的探讨肺减容术治疗慢性阻塞性肺气肿（COPD）对右心功能的影响。方法应用彩色多普勒超声技术，分别于术前、术后5～7d、术后12～14d、术后1个月、3个月测定26例接受肺减容术病人的右心收缩、舒张功能。结果右心收缩功能：术后5～7d心率（HR）、右心每搏输出量（RVSV）、右室射血分数（RVEF）、右室面积变化指数（FAC）降低（P〈0．01）；肺动脉平均压（PAP）、总肺血管阻力（TPR）增加（P〈0．05），术后12～14d上述指标除RVEF外与术前比较无统计学差异。术后3个月RVEF与术前比较无统计学差异。右室舒张功能：术后5～7d舒张早期快速充盈峰值流速（E），E峰流速积分（ETVI）、E／A下降，舒张晚期快速充盈流速（A），A峰流速积分（ATVI）增加（P〈0．01），术后3个月除E／A外与术前比较无差异。结论肺减容术后右心血流动力学指标可出现短暂变化，术后5～7d右心泵功能、舒张功能下降，肺动脉压及总肺血管阻力升高；收缩功能很快恢复，舒张功能恢复较慢。

Objective To observe the function changes of fight ventricular in chronic obstructive emphysema after lung volume reduction surgery. Methotls Twenty-six patients with chronic obstructive emphysema undergoing lung volume reduction surgery were examined by color Doppler echocardiography to determine systolic function and diastolic function of right ventricle in preoperative days and postoperative days of 5-7; 12-14; 1 month and 3 months. Results Contraction of right ventricle： comparing with prcoperative parameters, there were significant decrease （ P 〈 0.01 ） of right ventricular stoke volume （ RVSV ）, right ventricular ejection fraction （RVEF）, and right ventricular fraction of area change, significant increase （ P 〈 0.05） of pulmonary artery mean pressure （PAP） and total pulmonary vascular resistance （TPR） in the postoperative days 5 - 7; and except RVEF, there were no significant difference （ P 〉 0.05） of those above mentioned in postoperative days 12 - 14. It recovered at 3 month after operation. Relaxation of right ventricle ： the swift filling peak flow-rate in earlier relax period （E） and E flow-rate integra （ETVI） decreased meanwhile swif filling peak flow-rate in late relax period （A） and A flow-rate integra （ATVI） increased in the postoperative days 5 - 7 （ P 〈 0.01 ）. There was no significant difference between the markers mentioned above in preoperative days and three months after operation. Conclusion There were transient changes of right ventricle function after lung volume reduction surgery with decreased pump function, relax function and increased pulmonary arterial pressure and TPR in postoperative days 5 - 7. Pump function and pulmonary arterial pressure recovered earlier than relax function.