肺切除术对右心血流动力学影响及其意义  

作　　者：赵晓东 沈韦羽 潘海彬 田辉 毛争春 金成华 

机构地区：[1]浙江省宁波医疗中心李惠利医院胸外科,315040

出　　处：《浙江临床医学》2009年第10期1040-1041,共2页Zhejiang Clinical Medical Journal

摘　　要：目的 检测肺切除术中右心血流动力学及血气的变化，以观察肺切除术对心肺功能的影响，并探讨肺切除术后并发症与右心血流动力学和血气变化的关系。方法手术前置入漂浮导管分别于麻醉前、开胸单肺通气后、结扎肺静脉、结扎肺动脉和术毕关胸后测定平均动脉压（MAP）、中心静脉压（CVP）、平均肺动脉压（MPAP）、肺毛细血管楔压（PCWP）、肺血管阻力指数（PVRI）和外周血管阻力指数（SVRI），用温度稀释法测心排血量（CO），并通过计算得到心指数（CI）、每搏指数（SVI）。术前、术后2h、术后8h，以及术后第1天、第2天、第3天测动脉血气。结果开胸后MAP明显降低（P〈0．05），术中和术后CVP较术前明显增高（P〈0．01），开胸单侧肺通气、肺动脉和静脉结扎和术后MPAP明显增高（P〈0．01），在术毕关胸后较麻醉后MPAP亦明显增加（P〈0．01）。术后2d动脉血氧分压（PaO2）最低（P〈0．01），二氧化碳分压（PCO2）最高（P〈0．01）。结论肺切除术对右心血动力学变化有明显影响，但未发现与术后心肺并发症有明确的关系，术后低氧血症与术后心肺并发症有关。Objective To observe the influence the pneumonectomy has on the has on cardiorespiratory function, and to explore the relationship between the postoperative complication and the change of haemodynamics and blood gas of right heart, by examining the change of haemodynamics and blood gas of right heart during the pneumonectomy. Methods Mean arterial pressure （MAP） ,central venous pressure （CVP） , mean puhnonary arterial pressure （MPAP） , pulmonary capillary wedge pressure （ PCWP）, pulmonary vascular resistance index（PVRI） and peripheral vascular resistance index（SVRI） were measured at the time points of preanesthesia,one -lung ventilation ,pulmonary vein ligation ,puhnonary artery ligation and the thorax cavity closure respectively with floating catheter which was put postoperatively, temperature diluting methods was used to measure the cardiac output, the the cardiac index and stroke volume index were calculated. The arterial blood gas was measured at the time points of 2h pre -and post -operation, the first, second and third postoperative day respectively. Results The MAP decreased significantly after thoracotomy （ P 〈 0. 05 ）, the introoperative and postoperative CVP was significantly higher and that of operatively（ P 〈 0. 01 ）, PaO2 increased significantly 2 days postoperatively（ P 〈0. 01 ）, the（ PCO2 ） reached the highest（ P 〈 0. 01 ）. Conclusions Pneumonectomy has significant influential effect on change of haemodvnamics and blood gas of right heart, but no definite relationship is found to be related to the postoperative complications, while the postoperative hypoxemia is related to the postoperative cardiolpulmonary complications.

关 键 词：肺切除术 血流动力学 动脉血气分析 

分 类 号：R655.3[医药卫生—外科学] R614[医药卫生—临床医学]