心脏彩超测定Tei指数用于胸腔镜下与开胸肺叶切除术后心肌功能的临床评估

Clinical study of echocardiography detection of Tei index for evaluation of myocardial function after thoracoscopy and thoracotomy pulmonary lobectomy

目的:研究心脏彩超测定Tei指数用于胸腔镜下与开胸肺叶切除术后心肌功能评估的临床价值。方法:选择接受开胸肺叶切除术的患者48例和接受胸腔镜下肺叶切除术的患者42例进行研究,分别纳入开胸组和胸腔镜组。手术前后分别进行心脏超声检查,得到Tei指数、肺动脉平均压和收缩压以及右心室射血量(RVSV-3D)、射血分数(RVEF-3D)、舒张末期容积指数(RVEDVI-3D)、收缩末期容积指数(RVESVI-3D);采集血清检测脑钠肽(BNP)、C反应蛋白(CRP)、去甲肾上腺素(NE)、肾上腺素(E)含量。结果:手术后1周以及1、2、3个月时,胸腔镜组患者的Tei指数低于开胸组;手术后1周,胸腔镜组患者的肺动脉收缩压、平均肺动脉压、RVEDVI-3D、RVESVI-3D均低于开胸组(P<0.05),RVEF-3D、RVSV-3D均高于开胸组(P<0.05);胸腔镜组血清中BNP、NE、E、CRP含量低于开胸组(P<0.05);Tei指数与肺动脉收缩压、平均肺动脉压、RVEDVI-3D、RVESVI-3D呈正相关,与RVEF-3D、RVSV-3D以及血清BNP、NE、E、CRP含量呈负相关。结论:心脏彩超测定Tei指数能够准确评估胸腔镜下肺叶切除术后右心功能。

Objective.. To investigate the clinical value of echocardiography detection of Tel index for evaluation of myo eardlal function after thoracoscopy and thoracotomy pulmonary lobectomy. Methods： A total of 48 cases of patients who re ceived thoracotomy pulmonary lobectomy and 42 cases of patients who received thoracoscopy pulmonary lobectomy were select ed for study and enrolled in thoracotomy group and thoracoscopy group respectively. Before and after operation, echocardiography was conducted to obtain Tei index, mean pulmonary artery pressure and systolic pressure as well as right ventricle stroke volume, right ventricle ejection fraction, right ventricle end-diastolic volume index and right ventricle end-systolic vol- ume index~ serum was collected to detect BNP, NE, E and CRP contents. Results： 1 week, 1 month, 2 months and 3 months after undergoing operation, Tel indexes of thoracoscopy group were lower than those of thoracotomy group; 1 week after oper- ation, pulmonary artery systolic pressure, mean pulmonary artery pressure, RVEDVI-3D and RVESVI-3D of thoracoscopy group were lower than those of thoraeotomy group, and RVEF-3D and RVSV-3D were higher than those of thoracotomy group; serum BNP, NE, E and CRP contents of thoracoscopy group were lower than those of thoracotomy groupl Tel index was positively correlated with pulmonary artery systolic pressure, mean pulmonary artery pressure, RVEDVI-3D and RVES- VI-3D and negatively correlated with RVEF-3D and RVSV-3D as well as serum BNP, NE, E and CRP contents. Conclusion： Right heart function were better recovered after thoracoscopy pulmonary lobectomy, and echocardiography detection of Tei in- dex can accurately assess right heart function.