上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (3): 349-.doi: 10.3969/j.issn.1674-8115.2011.03.024

• 论著（临床研究） • 上一篇    下一篇

肺切除手术对肺癌患者右心功能的影响

陈 铭1, 方文涛1, 吴卫华2, 黄 艳2, 陈文虎1   

  1. 上海交通大学附属胸科医院 1.胸外科, 2.超声科, 上海 200030
  • 出版日期:2011-03-28 发布日期:2011-03-29
  • 作者简介:陈 铭（1974—）, 男, 主治医师, 硕士；电子信箱: hcmsh@hotmail.com。

Effects of pulmonary resection on right ventricular function in patients with lung cancer

CHEN Ming1, FANG Wen-tao1, WU Wei-hua2, HUANG Yan2, CHEN Wen-hu1   

  1. 1.Department of Thoracic Surgery, 2.Department of Ultrasound, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
  • Online:2011-03-28 Published:2011-03-29

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摘要：

目的 探讨肺切除对肺癌患者右心功能的影响。方法 47例肺癌患者根据手术方式分为肺叶切除组（n=32）和全肺切除组（n=15）。分别于术前和术后第3天和第8天，应用实时三维超声心动图测定右室舒张末期容积指数(RVEDVI)、右心室射血分数(RVEF)、肺动脉平均压(mPAP)和心率（HR），同时监测动脉血氧分压(PaO2)的变化。结果 术后第3天， 两组患者的mPAP、HR和RVEDVI均较术前显著增加(P<0.05)，RVEF则显著降低(P<0.05)，全肺切除组的改变更显著；肺叶切除组手术前后PaO2比较差异无统计学意义(P>0.05)，而全肺切除组术后PaO2较术前显著下降(P<0.05)。术后第8 天，肺叶切除组各项检测指标均恢复至术前水平，而全肺切除组各项检测指标与术前比较差异仍有统计学意义(P<0.05)。结论 肺切除手术尤其是全肺切除可引起右心功能降低，应尽可能以袖式支气管和血管成形术替代全肺切除，以减少手术创伤。

关键词: 实时三维超声心动图, 肺切除术, 右心功能

Abstract:

Objective To investigate the effects of pulmonary resection on right ventricular function in patients with lung cancer. Methods Forty-seven patients with lung cancer undergoing pulmonary resection were divided into lobectomy group (n=32) and pneumonectomy group (n=15). Real-time three-dimensional echocardiography were preformed before operation, 3 d and 8 d after operation to obtain the data of right ventricular end-diastolic volume index (RVEDVI), right ventricular ejection fraction (RVEF), mean pulmonary artery pressure (mPAP) and heart rate (HR), and arterial oxygen pressure (PaO2) was monitored simultaneously. Results Three days after operation, mPAP, HR and RVEDVI significantly increased, and RVEF significantly decreased in two groups (P<0.05), and the changes were more significant in pneumonectomy group. PaO2 after operation was significantly lower than that before operation in pneumonectomy group (P<0.05), while the decrease in PaO2 after operation was not statistically significant in lobectomy group (P>0.05). Eight days after operation, all parameters recovered to those before operation in lobectomy group, while there were still significant differences between all parameters before operation and those after operation in pneumonectomy group (P<0.05). Conclusion Right ventricular function may decrease after pulmonary resection, especially in patients treated by pneumonectomy. Sleeve resection of bronchus and pulmonary artery is recommended instead of pneumonectomy to achieve the better outcome.

Key words: real-time three-dimensional echocardiography, pulmonary resection, right ventricular , function