A Study On The Changes Of Right Cardiac Function In Perioperation For Pulmonary Resection

Background: Pulmonary resection is an effective therapy method for patients with lung cancer, pulmonary tuberculosis, pulmonary benign tumor. At present, Pulmonary resection technique and postoperative care have improved. However cardiovascular complication have approximately reached to 30% after pulmonary resection with increasement of operation indication and enlargement of operation range. So more and more cardiothoracic surgeons focus on the changes of right cardiac function in perioperation for pulmonary resection. Currently, little is known about different operation ways influnce on right cardiac function. Objective: To study on the changes of right cardiac afterload and right ventricle pumping function according to different operation ways after pulmonary resection by Doppler pulmonary flow spectrum. To explore the change of right ventricular contraction function after pulmonary resction by estimation of MPI. To explore the change of ANP and the correlation between ANP and right cardiac function after pulmonary resection. Methods: â‘  50 cases of pulmonary resection were divided into three groups. Group â… (12 cases) were treated by pneumonectomy, group â…¡(28 cases) by lobectomy and group â…¢(10 cases) by wedge resection. The changes of right cardiac afterload and right ventricular pumping function were evaluated by PEP, AT, VI, PAMP,PVR,RVSV at pre-operation, post-operation 3rd-5th day and post-operation 8th-10th day by Doppler pulmonary flow spectrum. â‘¡ To explore to change of right ventricle contraction function, RVET, IRT ,ICT and MPI were measured by tricuip relaxation pulsed Doppler flow spectrum and right ventricle outflow contraction spectrum. â‘¢ The change of plasma ANP level was investigated by radioimmonoassay at corresponding time point and the correlation between ANP and right cardiac function was explored. â‘£ Right cardiac function was compared according to whether or not COPD before operation and whether or not arrhythmia at postoperation. Results: â‘  Wedge resection didn't obviously influence on right cardiac afterload(PAMP and PVR) and right ventricular pumping function(RVSV). However PAMP and PVR evidently increased and RVSV decreased at post-pneumonectomy or lobectomy 3rd-5th day. Group â…  changed more odviously than group â…¡. The right cardiac afterload and right ventricular pumping function restored to the level of preoperation at post-lobectomy 8th-10th day. However the right cardiac afterload and right ventricular pumping function were still abnormal compared with preoperation at post-pneumonectomy 8th-10th day. â‘¡ MPI didn't change for wedge resection in perioperation. MPI evidently increased at post-pneumonectomy or lobectomy 3rd-5th day. MPI restored to the level of preoperation at post-lobectomy 8th-10th day and was still abnormal at post-pneumonectomy 8th-10th day. MPI was evidently positive correlation to PAMP, PVR(r=0.84,r=0.87)and was negative correlation to RVSV(r=-0.88). â‘¢ Plasma ANP of wedge resection didn't change. Plasma ANP level increased at post-pneumonectomy or lobectomy 3rd-5th day. It restored to the level of preoperation at post-lobectomy 8th-10th day. But it was higher than that of preoperation at post-pneumonectomy 8th-10th day. Plasma ANP was evidently positive correlation to PAMP, PVR, MPI (r=0.81,r=0.89,r=0.91)and was negative correlation to RVSV(r=-0.86). â‘£ PAMP, PVR,ANP and plasma ANP with COPD increased and RVSV decreased before operation. Conclusions: â‘ Wedge resection don't evidently influence on right cardiac function. However right cardiac function evidently decrease at post-pneumonectomy or lobectomy 3rd-5th day compared with preoperation.Group â… change more obviously than group â…¡. Right cardiac function of group â…¡ restore the level of preoperation and that of group â…  is still abnormal at 8th-10th day. â‘¡ We should properly evaluate right cardiac function except for evalution of lung function for patients with COPD before pulmonary resection. â‘¢Pulsed Doppler flow spectrum have some characteristics, such as noninvasion, safty, convenience,b...