Sumler Michele L, Andritsos Michael J, Blank Randal S
University of Virginia Health System, Charlottesville, VA 22908, USA.
Semin Cardiothorac Vasc Anesth. 2013 Mar;17(1):9-27. doi: 10.1177/1089253212453620. Epub 2012 Aug 14.
Interactions between the cardiovascular and respiratory systems are complex and profound. General anesthesia, muscle relaxation, and positive-pressure ventilation all impose physiological effects on cardiovascular function. In patients presenting for pulmonary resection, additional effects resulting from positioning, 1-lung ventilation, surgical procedures, and contraction of the pulmonary vascular bed may impose an additional physiological burden. For most patients with adequate pulmonary and cardiovascular reserve, these effects are well tolerated. However, the cardiothoracic anesthesiologist may be asked to provide anesthetic care for patients with significantly reduced cardiac function who require potentially curative pulmonary resection for lung cancer. These patients present a major perioperative challenge and a thoughtful approach to intraoperative management is required. The authors review a case of a patient with severely impaired biventricular function who presented for elective pulmonary lobectomy in an attempt to effect a curative resection of lung cancer and present a discussion of physiological and pathophysiological considerations for clinical management.
心血管系统与呼吸系统之间的相互作用复杂而深刻。全身麻醉、肌肉松弛和正压通气都会对心血管功能产生生理影响。对于接受肺切除术的患者，体位、单肺通气、手术操作以及肺血管床收缩所产生的额外影响可能会带来额外的生理负担。对于大多数肺和心血管储备充足的患者来说，这些影响能够得到良好耐受。然而，心胸麻醉医生可能会被要求为心功能显著降低、需要进行可能治愈性肺癌肺切除术的患者提供麻醉护理。这些患者面临重大的围手术期挑战，需要对术中管理采取深思熟虑的方法。作者回顾了一例双心室功能严重受损的患者接受择期肺叶切除术以试图实现肺癌根治性切除的病例，并对临床管理中的生理和病理生理考虑因素进行了讨论。
