Do Pulmonary Hemodynamics Change after Effective Lung Volume Reduction Surgery for Emphysema?

肺氣腫於肺容積縮減後，因呼吸動力學之改善而使肺功能、運動量、血氧分壓及症獲得進步。但另一個問題是，病人狀況之改善，是否因為手術後之肺血流動力學之變異而得之？惟手術前後之肺血管壓力變化之研究仍屬稀罕。本篇乃探討成功之肺容積縮減術後之肺血流動力學是否有意義變化，如有變化則其對病人之改善有關，反之亦然。他們於手術兩天前以心導管測量肺動脈收縮及舒張壓。術中，插入Swan Ganz　導管。在拔除胸管兩天後，在自然呼吸及穩定之情況下，用Swan Ganz　再次測量肺動脈壓。另外，血液氣體分析，肺功能及六分鐘步行試驗均在術前及術後三個月執行。數據收集後用Wilcoxon signed rank test來比較分析。比較術前後，雖然他們的肺功能，血氣分壓及症狀均改善，肺動脈壓並無有意義之變化。有效之肺容積縮減術後，肺功能及症狀之改善與肺血流動力學並無關係。

關鍵字

肺血流動力學；肺容積縮減術

並列摘要

The improvement in lung function, exercise test, blood gas levels, and symptoms in emphysema patients after volume reduction surgery is a result of improvements in breathing mechanics. The question is, is the improvement in the condition related to pulmonary hemodynamics? Few studies have examined preand postoperative pulmonary pressure. This paper examines whether there is any significant change in systolic and diastolic pulmonary pressure after effective volume reduction surgery. From October 1999 to October 2002, 12 emphysema patients who underwent volume reduction surgery were studied. Systolic and diastolic pulmonary pressures were measured 2 days before surgery through cardiac catheterization and 2 days after removal of the chest tubes through Swan Ganz catheters placed in the operating room just before surgery. Patients were stable and breathed without assistance during the postoperative pressure measurement. Blood gas analysis, lung function tests, and a 6-minute walk test were performed preoperatively and 3 months postoperatively. The two sets of data were compared using the Wilcoxon signed rank test. There was no significant change in pulmonary hemodynamics, although pulmonary function improved. The improvement in pulmonary function after volume reduction surgery is not related to pulmonary hemodynamics.

並列關鍵字