肺切除术后平均肺动脉压的变化及其意义

Increased mean pulmonary artery pressure in the patients with lung cancer during and after the procedures of pneumonectomy

目的观察肺切除术对右心功能的影响，并探讨肺切除术后心血管并发症与右心血流动力学关系及手术危险性。方法随机选择16例肺癌行肺切除术病例，采用Swan-Ganz漂浮导管的方法，分别于麻醉前、麻醉开胸单肺通气后及结扎肺静脉、结扎肺动脉和术毕关胸后瞬时测定平均动脉压（MAP）、心率（HR）、中心静脉压（CVP）、平均肺动脉压（MPAP）、平均肺毛细血管楔压（MPCWP），心排血量（CO），并通过计算得到心脏指数、左心室每搏作功指数、右心室每搏作功指数、每搏指数。记录患者术前、术后并发症。结果术后出现心血管并发症6例（37．5％），无手术和围手术死亡。术后MPAP较术前明显增高。MPAP〈25mmHg者12例，心血管并发症2例（16．7％）；MPAP〉26mmHg者4例，心血管并发症4例（100％）；两者比较差异有统计学意义（P〈0．05）。结论肺切除术对右心血流力学变化有影响，术后MPAP增高，发生心血管并发症危险性增高。

Objective To monitor right heart hemodynamic changes of patients with lung cancer during and after the procedures of pneumonectomy and discuss the effect of pneumonectomy on right heart function and risk of postoperation morbidities. Method 16 patients with lung cancer were randomly selected and the clinical database was queried and Swan-Ganz catheter was applied awake from jugular vein to pulmonary artery, measuring mean arterial pressure （ MAP ）, heart rate （ HR ）, central venous pressure （ CVP ）, mean pulmonary artery pressure （ MPAP ）, mean pulmonary capllary wedge pressure （MPCWP） , and cardiacc output （ CO ） and calculating cardiac index （ CI ） , left ventricular-stroke work index （LVSWI） ,right ventricular stroke work index （RVSWI） , and stmke volume index （SVI） instantaneously before anaesthesia, after anaesthesia with single lung ventilation, after pulmonary artery and pulmonary vein occlusion and supine chest closed during the procedure of pneumonectomy. Pre-and post-operative complications were recored. Results Cardiovascular complications occurred in 6 patients（37.5% ） postoperatively. There were no operative or perioperative deaths. MPAP increased significantly after the procedure of pneumonectomy compared with that of preoperation,and MPAP 〉26 mm Hg was in 4 patients who got cardiovascular complications postoperatively with morbidity of 100% ,which was significantly higher than the morbidity of 16.7% （2/12） when MPAP 〈 25 mm Hg. Conclusion Pneumonectomy has significant effects on right heart hemodynemic changes and as MPAP increases postoperatively, the risk of cardiovascular complications becomes higher.