Vaidya R, Husain T, Ghosh P K
Department of Cardiovascular and Thoracic Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
J Cardiovasc Surg (Torino). 1996 Jun;37(3):295-300.
New York Heart Association (NYHA) functional classification of cardiac patients is assessed by subjective impairment of respiratory reserve. We objectively studied pulmonary function by spirometry in 31 random patients (average age 27.2 years) with rheumatic mitral valve (MV) disease undergoing open surgery (7 reconstruction, 24 replacement) preoperatively, predischarge and at 3 month follow-up. Better preoperative spirometric parameters were observed in class II nonsmoker patients with smaller cardiothoracic ratio (CTR) and normal pulmonary artery pressure (PAP). After surgery mean PAP decreased to 19.0 +/- 6.7 mmHg, MV gradient dropped to 3.4 +/- 2.9 mmHg, average CTR decreased to 52.3 /- 5.5%. MV area increased significantly from 0.8 +/= 0.49 to 2.45 +/- 1.23 cm2. Forced vital capacity (FVC), forced expiratory volume in one second FEV1), flow rates at 25%-75% of expired vital capacity (FEF 25-75%) and maximum voluntary ventilation (MVV) decreased significantly in all patients at discharge. Prolonged postoperative ventilatory support over 10 hours led to markedly reduced predischarge FVC, FEV1, FEF50, MVV and maximum mid expiratory flow rate (MMEFR). Prolonged cardiopulmonary bypass over 80 minutes caused further decrease in FVC. After 3 months all these parameters improved in all above the preoperative level but remained below the predicted values. Despite improvement in NYHA class, impaired spirometry was observed in 11 patients. Functional or hemodynamic improvement did not correlate with spirometric changes.
纽约心脏协会（NYHA）根据呼吸储备的主观受损情况对心脏病患者进行功能分级。我们通过肺活量测定法对31例随机选取的风湿性二尖瓣疾病患者（平均年龄27.2岁）进行了客观的肺功能研究，这些患者在接受开放手术（7例重建，24例置换）前、出院前及3个月随访时进行了检测。在心胸比率（CTR）较小且肺动脉压（PAP）正常的II级非吸烟患者中观察到更好的术前肺活量测定参数。术后平均肺动脉压降至19.0±6.7mmHg，二尖瓣压差降至3.4±2.9mmHg，平均心胸比率降至52.3±5.5%。二尖瓣面积从0.8±0.49显著增加至2.45±1.23cm²。所有患者出院时用力肺活量（FVC）、一秒用力呼气容积（FEV1）、肺活量25%-75%时的流速（FEF 25-75%）和最大自主通气量（MVV）均显著下降。术后通气支持时间超过10小时导致出院前FVC、FEV1、FEF50、MVV和最大呼气中期流速（MMEFR）明显降低。体外循环时间超过80分钟导致FVC进一步下降。3个月后，所有这些参数均有所改善，超过术前水平，但仍低于预测值。尽管NYHA分级有所改善，但仍有11例患者肺活量测定结果受损。功能或血流动力学改善与肺活量测定变化无关。
