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由于解剖性肺切除术的手术程序,左心室每搏输出量减少。

Left ventricular stroke volume decreases due to surgical procedures of anatomical lung resection.

机构信息

Department of Thoracic Surgery, Ina Central Hospital, Nagano, Japan.

Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Nagano, Japan.

出版信息

Thorac Cancer. 2024 Oct;15(28):2021-2028. doi: 10.1111/1759-7714.15434. Epub 2024 Aug 22.

Abstract

OBJECTIVES

The influence of lung resection on cardiac function has been reported, and previous studies have mainly focused on right ventricular (RV) dysfunction. As few studies have analyzed changes in left ventricular hemodynamic variables caused by lung resection, we aimed to investigate the perioperative changes in left ventricular stroke volume (LVSV) caused by anatomical lung resection.

METHODS

We enrolled 61 patients who underwent anatomical lung resection and perioperative LVSV monitoring. The Flo Trac system was used for dynamic monitoring. We investigated changes in LVSV after lung resection and the factors that affected these changes. The operative procedures that contributed to these changes were also investigated.

RESULTS

LVSV decreased after anatomical lung resection in the majority of patients (n = 38, 62.2%). Operative procedures affecting this change were (a) taping the superior pulmonary vein (SPV; right: V1-3) before dorsal part procedure (e.g., major fissure division of right upper lobectomy, A1 + 2c, and A4 + 5 division of left upper lobectomy); (b) division of the SPV (right: V1-3, V4 + 5); (c) division of A6-10 (in lower lobectomy); and (d) finish division of all vessels.

CONCLUSIONS

LVSV decrease was caused by anatomical lung resection in the majority of patients owing to the intraoperative procedures described above.

摘要

目的

已有研究报道肺切除对心功能的影响,既往研究主要集中于右心室(RV)功能障碍。由于鲜有研究分析肺切除引起的左心室血流动力学变量变化,我们旨在研究解剖性肺切除导致的围术期左心室每搏量(LVSV)变化。

方法

我们纳入了 61 例行解剖性肺切除术并接受围术期 LVSV 监测的患者。采用 Flo Trac 系统进行动态监测。我们研究了肺切除后 LVSV 的变化以及影响这些变化的因素。还研究了导致这些变化的手术操作。

结果

大多数患者(n=38,62.2%)在解剖性肺切除后 LVSV 下降。影响这一变化的手术操作包括(a)在背部分离前(如右上肺叶切除术的主裂分离、A1+2c 和 A4+5 以及左上肺叶切除术的 A6-10 分离)捆绑上肺静脉(SPV;右侧:V1-3);(b)SPV 分离(右侧:V1-3、V4+5);(c)A6-10 分离(下肺叶切除术);和(d)完成所有血管的分离。

结论

由于上述术中操作,大多数患者在解剖性肺切除后出现 LVSV 下降。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c28/11444926/67b40212aedb/TCA-15-2021-g004.jpg

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