微创漏斗胸矫治术后早期心肺功能变化的研究

Early effects study on cardiopulmonary function of minimally invasive pectus excavatum repair （NUSS procedure）

目的 了解胸腔镜下微创漏斗胸矫治术（Nuss手术）治疗漏斗胸术后早期患者心肺功能的变化.方法 2006年l2月-2009年7月,我院共有23例漏斗胸患者采用胸腔镜下Nuss手术进行矫治,其中13例大于9岁的漏斗胸患者行术前、术后3个月和术后1年的肺功能检测,包括肺活量（VC）、肺总量（TLC）、用力肺活量（FVC）、第1秒用力呼气容积（FEV1）和50%肺活量最大呼气流量（MEF50）.所有23例患者均行术前、术后3个月和术后1年的心功能检测,包括每搏量（SV）、心输出量（CO）和心脏指数（CI）.结果 术后3个月TLC、VC、FEV1、FVC均较术前下降,其中VC、FEV1、FVC下降明显[VC：（81.08±12.74）vs（92.15±11.36）;FEV1：（83.54±10.81）vs（93.62±10.76）;FVC：（85.92±10.59）vs（93.85±10.18）,P＜0.05],术后1年均可恢复到术前水平（P＞0.05）.MEF50术后3个月未见明显下降,术后1年较术前升高（P＞0.05）.术后3个月、术后1年每搏量和心输出量均较术前有显著提高（P＜0.05）;术后3个月、术后1年心脏指数均较术前有提高,其中术后3个月提高明显[（3.45±0.42）vs（3.15±0.42）,P＜0.05].结论 微创漏斗胸矫治术后患者早期肺功能虽有下降,但术后随访显示可恢复至术前水平,而术后早期患者的心功能较术前有提高.

Objective To investigate the early effects on cardiopulmonary function of minimally invasive pectus excavatum repair （NUSS procedure）. Methods From December 2006 to July 2009, 23patients with pectus excavatum were treated with the Nuss procedure at Jiangmen Central Hospital. 13patients older than 9 years were received pulmonary function tests including vital capacity（VC）, total lung capacity（TLC）, forced ventilatory capacity（FVC）, forced expiratory volume in the first second（FEV 1） and maximal expiratory flow in 50% vital capacity（MEF50） at prior to operation, 3 months and 1 year after the Nuss procedure. All the patients were received cardiac function including stroke volume（SV）, cardiac output （CO） and cardiac index（CI） at prior to operation, 3 months and 1 year after operation. Results VC、FEV 1 and FVC decreased significantly at 3 months after operation and came back to the preoperative levels at 1 year after operation. MEF50 reduced lightly at 3 months after operation and increased at 1 year after operation compared with the preoperative value（P〉0.05）. Compared with the preoperative values, stroke volume （SV） and cardiac output （CO） increased significantly at 3 months and 1 year after operation. Cardiac index （CI） was improved significantly only at 3 months after operatiot. Conclusion Pulmonary function declined initially after Nuss procedure, and improved gradually to preoperative value during follow-up.Cardiac function was improved significantly compared to preoperative value after Nuss procedure.