胸阻抗法对不同术式肺叶切除患者围术期心功能变化的评价  

Evaluation of thoracic electrical bioimpedance on the changes of perioperative cardiac function for patients with different operative lobectomy

作　　者：汪高磊 邢宇彤[1] 戚家峰[1] 罗艳卓[1] 周钢[1] WANG Gao-lei;XING Yu-tong;QI Jia-feng;LUO Yan-zhuo;ZHOU Gang(Department of Cardio-Thoracic Surgery,the First Affiliated Hospital of Jiamusi University,Jiamusi 154003,China)

机构地区：[1]佳木斯大学附属第一医院胸心外科,黑龙江佳木斯154003

出　　处：《黑龙江医药科学》2018年第3期83-85,共3页Heilongjiang Medicine and Pharmacy

摘　　要：目的:比较胸阻抗法(thoracic electrical bioimpedance,TEB)与彩色多普勒超声心动图(color doppler echocardiography,CDE)测定心功能的差异及相关性,进而运用TEB评价传统开胸与电视胸腔镜肺叶切除患者手术前后心功能的变化。方法:对2014-09~2017-05入院行胸腔镜及开胸肺叶切除术患者各30例,术前应用超声心动图并于术前、术后第1天、术后第3天分别应用TEB测定患者心功能。结果:应用TEB与CDE所测心功能指标CO、SV、LVEF对比差异无统计学意义(P>0.05),且呈明显正相关(r=0.904、r=0.867、r=0.918,P均<0.05)。胸腔镜组与开胸组手术后所测得的SV、LVEF较术前下降,HR上升(P均<0.05),CO手术前后差异无统计学意义(P>0.05)。两组术前至术后第一天心功能指标的变化幅度相比,胸腔镜组患者的HR、SV较开胸组变化幅度较小(P<0.05),差异具有统计学意义,CO、LVEF的变化幅度差异无统计学意义。两组术后第一天至第三天心功能指标的变化幅度相比,胸腔镜组患者的LVEF较开胸组改善幅度较大(P<0.05),而CO、HR、SV的变化幅度两组相比无明显差异(P>0.05)。结论:运用TEB的无创血液动力学监测仪与超声心动图具有明显的相关性,其结果准确,可持续监测,且操作无创,使用方便,具有重要的临床应用价值;胸腔镜及传统开胸肺叶切除术后均对心功能有一定程度的影响,且腔镜组明显优于开胸组,胸腔镜肺叶切除能有效减少手术对心功能的影响,对患者的术后康复及生活质量的提高具有重要意义。Objective:To compare the difference and correlation between thoracic electrical bioimpedance and Doppler echocardiography in the measurement of cardiac function;and to evaluate cardiac function changes of video-assisted thoracoscopic lobectomy and open lobectomy on perioperative by TEB.Methods:60 patients who underwent video-assisted thoracoscopic lobectomy and open lobectomy between September 2014 and May 2017 in hospital were chosen.Echocardiography was used to measure the cardiac function of these patients before operation.TEB was used to measure the cardiac function before operation,the first day and the third days after operation.Results:There was no significant difference in CO,SV and LVEF between TEB and CDE(P>0.05);and there was significant positive correlation(r=0.904、r=0.867、r=0.918,P<0.05).After operation,the SV and LVEF in patients in both video-assisted thoracoscopic lobectomy group and open lobectomy group were decreased compared with preoperative(P<0.05).HR was significantly higher than preoperative(P<0.05).However,there was no significant difference in CO on perioperative(P>0.05).Compared with the variation range of cardiac function parameters between the two groups from preoperative to the first day after operation,the variation range of HR and SV were significantly lower in the video-assisted thoracoscopic lobectomy group than those in the open lobectomy group(P<0.05).There was no significant difference in the variation range of CO and LVEF(P>0.05).Compared with the variation range of cardiac function parameters between the two groups from the first day to the third day after operation,the improvement range of only LVEF in the video-assisted thoracoscopic lobectomy group was significantly higher than that in the open lobectomy group(P<0.05).There was no significant difference in the variation range of CO,HR and SV(P>0.05).Conclusion:The noninvasive hemodynamic monitor by using TEB has a significant correlation with echocardiography.The result is accurate,continuous monitoring,non-invasive,an

关 键 词：胸阻抗法 超声心动图 心功能 胸腔镜肺叶切除术 

分 类 号：R655.3[医药卫生—外科学]