Impact Between Pulmonary Resection And Cardiopulmonary Hemodynamics Assessed By Noninvasive Echocardiography

Part 1 Impact of pulmonary hypertension on patients with lung resectionObjective We sought to determine the predictors of perioperative morbidity and mortality after pulmonary lobectomy in patients with pulmonary hypertension(PH).Methods The details of consective patients and perioperative complications during the period between January 2008 to December 2012. 253 patients who underwent lung resection were enrolled to this study. Adult patients who and had a transthoracic echocardiogram(TTE) performed within the three days prior to the operation were included. Pulmonary hypertension was defined as an estimated Pulmonary artery systolic pressure(SPAP)of ≥40mm Hg by TTE. These cases were divided into two groups, including the group without pulmonary hypertension(241 patients) and one with pulmonary hypertension(12 patients). The preoperative characteristics, intraoperative data and postoperative outcomes of patients with and those without pulmonary hypertension based on TTE were compared. perioperative morbidity that included prolonged intubation, arrhythmias in first 48 h following the surgery, hemodynamic instability and ICU of stay, hospital length of stay were discussed.Results The incidence of all complications in pulmonary hypertension group, arrhythmias in first 48 h following the surgery, hemodynamic instability, prolonged intubation, ICU of stay was respectively 58.3%, 50%, 41.7%, 50%, 4.3 ± 0.8d, and 27.0%, 20.4%, 13.7%, 17.4%, 3.0 ± 0.8d in another group. There were significant difference in those parameter. In the Pulmonary hypertension group, the hospital length of stay was 15.1 ± 4.5d. Another group was 14.8 ± 3.1d. The difference was not statistically significant.Conclusions In addition to the traditional known risk factors for outcomes after lobectomy such as coronary artery disease, diabetes mellitus, the presence of underlying PH may have a significant negative impact on perioprative outcomes.Part 2 Assessment of cardiopulmonary parameters in perioperative lobectomy patients by noninvasive ultrasound in clinical applicationObjective To discuss the changes of pulmonary artery pressure and right ventricular function by noninvasive Doppler echocardiography in the perioperative period of lobectomy, and to optimize better perioperative clinical managements;Methods Noninvasive colour Doppler echocardiography were performed on 35 patients suffered lobectomy during the perioperative period; Hemodynamic parameters were examed and were analyzed statistically by preoperative and postoperative self-control methods,such as: pulmonary vascular resistance, pulmonary systolic blood pressure, right ventricular Tei index.Results All of the preoperative parameters were normal in this study. Comparing with preoperative hemodynamic parameters, there were statistically significant in increase of SPAP, PVR and right ventricular Tei index in the postoperative 3 to 5 days; In the postoperative 8 days, the difference was not statistically significant.But there were statistically significant in increase of VC, FRC, MVV, FEV1 and Pa CO2 in the postoperative 8 days. Pa O2 increased in the postoperative 8 days.Conclusion Lobectomy have a negtive infuence on the right ventricular function and pulmonary hemodynamic parameters durig the perioperative period, and non-invasive ultrasound is a promising method for cardiopulmonary function for patients underwent lobectomy.