Uno T, Kitano T, Noguchi T, Honda N, Chikama H, Tanaka K
Department of Anesthesiology, Oita Medical University.
Masui. 1993 Oct;42(10):1459-63.
Elevation of right ventricular afterload associated with the decrease of pulmonary vascular bed is a serious problem immediately after pneumonectomy. We studied the alteration of right ventricular performance and hemodynamics by using an RVEF thermodilution catheter, and compared them among 6 patients after pneumonectomy and 8 patients after pulmonary lobectomy. Results demonstrate that 1) PVRI increased significantly immediately after the pneumonectomy, and recovered to the preoperative level on the 1st postoperative day. On the other hand, in the lobectomy patients, PVRI showed no significant change throughout the operation, because the decrease of pulmonary vascular bed after pneumonectomy was larger than that after pulmonary lobectomy. 2) In the pneumonectomy group, CI and RVEF were preserved and right ventricular works (RCWI and RSWI) increased in spite of an increase of right ventricular afterload after the ligation of the pulmonary artery. We considered that immediately after pneumonectomy the increase of right ventricular afterload associated with decreased pulmonary vascular bed was compensated by increasing right ventricular work. 3) On the 1st postoperative day, CI and RVEF did not change, but mRAP decreased significantly, and PVRI and right ventricular works recovered to the preoperative level in the pneumonectomy patients. From the above results, we considered that after the pneumonectomy, increased right ventricular afterload was compensated by the decreased circulating blood volume.
与肺血管床减少相关的右心室后负荷升高是肺切除术后即刻出现的严重问题。我们使用右心室射血分数热稀释导管研究了右心室功能和血流动力学的变化，并在6例肺切除术后患者和8例肺叶切除术后患者中进行了比较。结果表明：1）肺切除术后即刻肺血管阻力指数（PVRI）显著升高，并在术后第1天恢复到术前水平。另一方面，在肺叶切除患者中，PVRI在整个手术过程中无显著变化，因为肺切除术后肺血管床的减少大于肺叶切除术后。2）在肺切除组中，尽管肺动脉结扎后右心室后负荷增加，但心脏指数（CI）和右心室射血分数（RVEF）得以保留，右心室作功（右心室每搏功指数RCWI和右心室每分功指数RSWI）增加。我们认为肺切除术后即刻，与肺血管床减少相关的右心室后负荷增加通过增加右心室作功得到了代偿。3）在术后第1天，肺切除患者的CI和RVEF未改变，但平均右房压（mRAP）显著下降，PVRI和右心室作功恢复到术前水平。根据上述结果，我们认为肺切除术后，右心室后负荷增加通过循环血容量减少得到了代偿。
