肺切除术影响围手术期右心功能

Effects of pulmonary resection on periopertive right ventricular function

目的检测肺切除术后围手术期右心功能指标的变化，以指导临床治疗。方法将肺切除病人45例分为肺楔形切除组（Ⅰ组，10例）、单肺叶切除组（Ⅱ组，19例）、双肺叶切除组（Ⅲ组，7例）及全肺切除组（Ⅳ组，9例）。通过中心静脉压（CVP）测定、脉冲多普勒血流频谱及组织多普勒技术了解术前、术后5—7d、术后1个月的右心室前、后负荷及泵功能变化。结果与术前相比，各种术式术后5—7d中心静脉压均无明显变化；Ⅰ组术后右心后负荷、泵功能较术前无明显改变；Ⅱ组、Ⅲ组及Ⅳ组术后5—7d右心后负荷增加，右心泵功能下降，Ⅳ组更为明显；术后1个月，Ⅱ组右心后负荷、泵功能恢复到术前水平，但Ⅲ组及Ⅳ组与术前相比仍有异常。结论肺切除术后存在不同程度的右心功能下降。

Objective To investigate the changes of pefioperative fight ventricular function after pulmonary resection. Methods 45 eases of pulmonary resection were divided into four groups. Group Ⅰ was wedge resection（n = 10 ）, Group Ⅱ was lobectomy（n = 19）, Group Ⅲ was double lobectomy（n = 7） and Group Ⅳ was pneumoectomy（n= 9）. The changes of CVP, PAMP, PEP/ET, Sa, VTIs, RVSP, Ea/Aa, and Tei were evaluated by traditional ultrasonic and tissue Doppler ultrasonic techniques at different time intervals （pre-operation, 5 - 7 days or/and 1 month post-operation）. Results Compared with the pre-operation CVP, the indexes of all groups have no significant changes post-operatively. Wedge resection didn＇ t obviously influence fight cardiac after load and systolic function/diastolic function. No evident changes detected in Tei pre-and post-operatively. However, the indexes （PAMP, RVSP and PEP/ET ratio） reflecting right cardiac afterload evidently increased at post-pneumonectomy or lobectomy group 5 - 7 days post-operative. All these reflect the decrease of Tel, which was more obvious in pneumonectomy than in lobectomy group. Right cardiac afterload, systolic/diastolic function and Tei index recovered to pre-operative level 1 month post-operafion in single lobectomy group. But the above indicators, especially the Tei, were still high in double hibectomy and pneumonectomy groups 1 month post-operation. Tei index is positively correlated with PAMP and is weakly correlated with PET/ET ratio and Ea/Aa ratio. Conclusion Pulmonary wedge resection doesn＇ t evidently influence right cardiac function. However, right cardiac diastolic function evidently decreases temporarily at lobectomy group. The systolic function and diastolic functions decrease after double-lobectomy and pneumonectomy and it＇s mere evident in pneumonectomy group. Though the right cardiac afterloads of lobectomy, double lobectomy and pneumonectomy groups all increase significantly post-operativlye, only the former recover to pre-operative level 1 month after surgery.