Ohishi A, Kanno R, Takano Y, Suzuki H, Usuba A, Inoue H, Motoki R
First Department of Surgery, Fukushima Medical College, Japan.
Nihon Geka Gakkai Zasshi. 1991 Oct;92(10):1503-8.
After pneumonectomy, it is recognized that the absolute reduction of the pulmonary vascular bed makes the right ventricular afterload increase and can cause right heart failure in patients with low cardiopulmonary reserve. Therefore, we investigated how the right ventricular load was predicted by UPAO test, comparing hemodynamics at the time of the test with those after pneumonectomy in patients with lung cancer. At the test, the absolute reduction of the pulmonary vascular bed made the right ventricular afterload increase but the right ventricular pump function was maintained at the preoperative level by the increase of the right ventricular work load, namely, by the contraction of the right ventricle. After pneumonectomy, the absolute reduction of the vascular bed did not always make the afterload increase and in spite of the decreased preload the pump function was maintained at the preoperative level by increased heart rate. Additionally, the increase of the right ventricular work load improved during early postoperative days. It was concluded that UPAO test was apt to overestimate the right ventricular load of the postoperative day because it was done under the condition of the different compensatory function from the postoperative hypovolemic change.
肺切除术后，人们认识到肺血管床的绝对减少会使右心室后负荷增加，并可能导致心肺储备功能低下的患者发生右心衰竭。因此，我们研究了如何通过UPAO试验预测右心室负荷，比较了肺癌患者试验时的血流动力学与肺切除术后的血流动力学。在试验中，肺血管床的绝对减少使右心室后负荷增加，但右心室泵功能通过右心室工作负荷的增加，即右心室的收缩，维持在术前水平。肺切除术后，血管床的绝对减少并不总是使后负荷增加，尽管前负荷降低，但泵功能通过心率增加维持在术前水平。此外，术后早期右心室工作负荷的增加有所改善。得出的结论是，UPAO试验容易高估术后当天的右心室负荷，因为它是在与术后血容量减少变化不同的代偿功能条件下进行的。
