超声检测肺解剖切除术围手术期右心功能的临床价值

摘要

Objective To discuss the changes of pulmonary artery pressure and right ventricular function by noninvasive echocardiography in the perioperative period of lobectomy,and to optimize better perioperative clinical managements. Methods Noninvasive echocardiography were performed on 35 patients received lobectomy during the time before operation,on the 3~5th day and the 8th day after operation. Data of the pulmonary vascular resistance and pulmonary artery systolic pressure and right ventricular Tei index were examined and analyzed statistically. These data were used to explore the changes of right heart function in the perioperative period,and compare the effects of early pulmonary function after resection. Results Systolic pulmonary artery pressure,pulmonary vascular resistance and right ventricular Tei index during postoperative 3~5th day were significantly higher than preoperative parameters. Pulmonary function was significantly decreased in the early stage after lung resection , and the difference was statistically significant(VCmax,FVC,FEV1,MVV,PaCO2,PaO2,SO2) between the level of preoperative and postoperative 8th day(all P<0.05). Conclusion During the early stage of lung resection not only pulmonary function was significantly decreased,but also right ventricular parameters were significantly changed. Non-invasive cardiography plays an important role and can provide guidnce for clinical treatment.%目的：应用无创超声检测肺解剖切除术围手术期肺动脉压及右心功能变化，并探讨其临床应用价值。方法选取行肺解剖切除术且肺功能正常患者35例，通过术前、术后第3～5天和术后第8天多普勒超声无创检测肺血管阻力、肺动脉收缩压、右心Tei指数，观察围手术期间右心功能的变化，同时比较肺解剖切除术后早期肺功能的影响。结果肺解剖切除术后第3～5天肺动脉收缩压、肺血管阻力及右心Tei指数均较术前升高，差异均统计学意义（均P＜0．05）；术后第8天上述右心参数恢复至术前水平，与术前比较差异无统计学意义。肺解剖切除术后早期肺功能明显下降；术后第8天反映肺功能指标的最大肺活量、用力肺活量、第1秒用力呼气量、最大分钟通气量、动脉氧分压、动脉二氧化碳分压及动脉血氧饱和度均低于术前，差异均有统计学意义（均P＜0．05）。结论肺解剖切除术患者术后早期不仅肺功能下降，而且右心参数变化明显，应用无创超声评估右心血流动力学对临床治疗有重要参考价值。