肺切除手术对高龄患者左心血液循环动力学的影响

Effect of lung resection surgery on left heart hemodynamics in elderly patients

目的 探讨肺切除手术对高龄患者左心血液循环动力学的影响,以及其与术后发生心律失常的相关性. 方法选取接受侧开胸肺切除手术的75岁及以上高龄患者16例和60岁以下对照组患者21例,监测记录术前、术毕、术后第1天的多项血液循环动力学参数.对于术后3 d内发生心律失常的患者,分别记录发生前后的各项参数. 结果两组病例手术前后心率、平均动脉压、心排量、心搏出量、加速指数、体血管阻力均无显著变化（均P＞0.05）.中心静脉压术毕较术前增高[高龄组：（5.92±0.51）cm H2O（1 cm H2O=0.098 kPa）对（7.58±0.45）cm H2O,t=2.641,P＜0.01;对照组：（6.23±0.47）cm H2O对（7.49±0.34）cm H2O;t=1.982,P＜0.05],术后第1天即恢复至术前水平（P＞0.05）.高龄组心律失常发生率为31.3%明显高于对照组的14.3%：（x2=4.26,P＜0.05）,但心律失常发生前后的各项参数与手术前比较均无明显变化（P＞0.05）. 结论在术前充分评估,术中注意心肺功能保护的前提下,通过术后严密监护以及正确及时的临床处理,完全可以避免肺切除手术对高龄患者左心血液循环动力学的影响.即使对于术后出现心律失常的患者,肺切除手术也未影响其左心血液循环动力学.

ObjectiveTo observe the effects of lung resection surgery on left heart hemodynamics in elderly patients, and explore its correlation with postoperative arrhythmia.Methods The 16 elderly patients （age≥75 years） receiving lung resection surgery were selected. At the same time, 21 patients （age〈60 years） were selected as controls. The hemodynamic parameters of each patient were recorded at the time of preoperative （T1）, surgery completion （T2） and first day after surgery （T3）. For patients with arrhythmia during three days after operation, the parameters would be recorded before and after arrhythmia. Results There were no significant changes in heart rate （HR）, mean arterial pressure （MAP）, cardiac output （CO）, cardiac stroke volume （ SV）,acceleration index （ACI）, systemic vascular resistance （SVR） at T2 and T3 compared with T1 for both the two groups （P〉0. 05）. Only the central venous pressure （CVP） increased at T2 compared with that at T1 [elderly group： （7.58±0.45） cm H2O vs. （5.92±0. 51） cm H2O, t=2.641, P〈0.01; control group： （7.49±0.34） cm H2O vs. （6.23±0.47） cm H2O, t=1.982, P〈0.05], while the CVP recovered to the preoperative level at T3. The incidence of arrhythmia was significantly higher in elderly group than in control group （31.3% vs. 14.3%, x2 = 4.26, P〈0.05）, but there were no significant changes in the parameters before and after arrhythmia compared with those before surgery （P 〉 0. 05 ）.Conclusions The effects of pulmonary resection surgery on left heart hemodynamics in elderly patients can be avoided through full assessment preoperatively, heart-lung protection intraoperatively, as well as the correctly and timely clinical treatment and intensive care postoperatively. Pulmonary resection surgery has no effect on left heart hemodynamics even for patients with postoperative arrhythmia.