肺癌术后运动能力和血流动力学的研究

Study of Exercise Capacity and Hemodynamic after Resection of Lung Cancer

目的 研究肺癌行肺切除术对运动能力下降和血流动力学变化的机理和影响因素,正确评估运动能力的恢复过程。方法 32例肺癌行肺切除术(左肺单叶切除14例,右肺单叶切除16例,右肺双叶切除2例)。分别在术前3～7天、术后1周、2周、3个月、6个月进行肺功能、心肺运动功能和血流动力学测定。8例病人术前3～7天和术后3个月分别测定血流动力学。结果 肺功能的变化主要包括术后3个月用力肺活量(FVC),第1秒用力呼气量(FEV1)、最大通气量(MVV)均明显下降,与术前相比分别下降了37％,21％和19.5％。心肺运动功能测定:最大负荷时分钟通气量(V_E)、潮气量(V_r)以及最大氧耗量(VO_2max)术后3个月下降最为明显,尤其是VO_2max由术前的1247±210ml/min术后3个月下降至950±261ml/min(P<0.05)下降幅度达23％,术后6个月恢复到1150±263ml/min,其绝对值仍然低于术前。血流动力学测定显示:心输出量(CO)由术前的12.7±1.38L/min术后3个月下降为11.3±1.2L/min,平均肺动脉压(mPAP)由术前的26.6±4.8mmHg术后3个月上升为35.0±6.2mmHg,肺血管阻力(PVR)术前1.48±0.3dyn.s.cm^(-5)术后上升为1.81±0.4dyn.s.cm^(-5)(P<0.05)。结论 肺癌行肺叶切除术后早期运动能力明显下降和肺血管阻力增加主要由于肺通气和血流减少所致。

Objective To investigate the mechanism and limitation of exercise capacity and hemodynamic data after resection for lung cancer and to assess subsequent recovery postoperatively. Methods Thirty-two patients had undergone resection (left lobectomy in 14,right lobectomy in 16, and right bilobectomy in 2) of lung cancer and been given a routine pulmonary function test (PFT ) and a cardiopulmonary exercise test from 3 to 7 days preoperatively and in 1 week,2 weeks, 3 months and 6 months postoperatively.Eight patients underwent hemodynamic test in preoperation and postoperation (3 months after operation ). Results 3 months after surgery PFT results of FVC, FEV1 and maximum ventilatory volumes(MVV) significantly decreased. In comparison with preoperative values, the functional percentage losses about 37% for FVC,21% for FEV1 and 19.5% for MW, respectively. Cardiopulmonary exercise test results of minute ventilation (VE ). tital volume (VT) and maximum oxygen consumption (VO2max) decreased significantly 3 months after operation and improved after more than 6 months. Especially VO2max decreased from 1247 ± 210 ml/min after operation. In comparison with preoperative values it increased from 26.6±4.8 mmHg to 35 ± 6.5 mmHg for mPAP.and exercise capacity was lower than preoperative,which was caused by the chest wall injury, and from 1.48 ±0.3 dyn.s.cm-5 to 1.81 ±0.4 dyn.s.cm-5 for PVR. Conclusions The initial drop of exercise capacity after resection of lung cancer seems to be derived from both circulatory and ventilation decrease, in which the exercise capacity subsequently recovered within 3 months.6 months after surgery the absolute value of exercise capacity was lower than that of preoperation, which was caused by the chest wall injury.