肺减容术后早期右心功能及肺功能的变化

Early changes in right ventricular and pulmonary functions after lung volume reduction surgery

目的探讨肺减容术后早期右心功能及肺功能的变化。方法对26例接受肺减容术患者应用彩色多普勒超声技术，于术前、术后5～7d、12～14d、术后1个月、术后3个月测定右心功能多项指标，并于术前、术后分次测定肺功能指标。结果①右心功能：术后5～7d右心每搏输出量（RVSV）、右心射血分数（RVEF）、右室面积变化指数（FAC）、舒张早期快速充盈峰值流速（E）、E峰流速积分（ETVI）、E／A降低；舒张晚期快速充盈流速（A）、A峰流速积分（ATVI）增加，与术前比较差异均有统计学意义（P〈0．01）。术后12～14d，RVSV、FAC与术前比较差异无统计学意义；术后3个月RVEF、E、ETVI、A、ATVI与术前比较差异无统计学意义。②肺功能：与术前比较，术后14d最大通气量（MVV）下降（P〈0．01），残气量增加（P〈0．05），术后1个月基本恢复至术前水平（P〉0．05）。术后3个月MVV较术前增加（P〈0．01），残气量减少（P〈0．05）。结论肺减容术后5～7d右心功能下降，收缩功能恢复较快，舒张功能恢复较慢。术后早期肺功能一过性下降，术后1个月恢复，术后3个月明显改善。

Objective To explore early changes in right heart function and pulmonary function after lung volume reduction surgery （LVRS）. Methods Twenty-six patients who underwent LVRS were examined by echocardiography, whereby parameters of right heart function before operation and at postoperative day 5-7,12-14, month 1 and 3,and pulmonary function before operation and at different postoperative times were measured for auto-control analysis. Results Right heart function： Right ventricular stroke volume（RVSV）, right ventricular ejection fraction（RVEF）, fraction area change（FAC）, peak velocity of early diastolic filling（E）, time-velocity integral of E wave（ETVI） and E and A wave velocities ratio（E/A） were decreased while peak velocity of late diastolic filling（A） and time-velocity in tegral of A wave（ATVI） were increased at postoperative day 5-7, the difference being statistically significant as compared with those before operation （ P〈0.01）. There was no statistically significant difference in RVSV and FAC between postoperative day 12-14 and before operation. There were no statistically significant differences in RVEF,E,ETVI, A and ATVI between three months after operation and before operation. Pulmonary function： Compared with those before operation, maximal ventilatory volume （MVV） was decreased and residual volume was increased at postoperative day 14 （ P〈0. 05）,and they returned to the preoperative levels one month after operation （ P 〈0.05）. Compared with those before operation, MVV was increased （ P 〈0.01） and residual volume was decreased （ P .（0.05） three months after operation. Conclusions Right heart function decreased 5-7 days after LVRS,systolic function of which recovered soon and diastolic function of which recovered more slowly. Pulmonary function decreased transiently in the early stage, returned to normal one month after operation,and improved significantly three months after operation.