Application Of Bedside Ultrasound In The Evaluation Of Cardiac Function And Diagnosis Of Pulmonary Complications After Lung Cancer Resection

Objective:Quantitative parameters of bedside echocardiography were used to observe the changes of cardiac function in early stage after lung cancer resection by different surgical methods,and to explore the value of bedside echocardiography in the diagnosis of pulmonary complications in perioperative period after lung cancer resection.Methods:?1?101 patients undergoing lung cancer resection were divided into wedge resection group?n=25?,lobectomy group?n=48?and pneumonectomy group?n=28?.The most effective and commonly used cardiac function parameters,right ventricular systolic and diastolic function indexes were collected at 48 hours before operation and 3-6hours,12-24 hours,48-96 hours and 144-192 hours after operation according to the latest American Academy of Echocardiography?ASE?guidelines.Systolic displacement?TAPSE?,right ventricular myocardial performance index?Tei index?,early tricuspid diastolic peak blood flow/early tricuspid annular diastolic peak velocity?E_t/e_t?;right ventricular afterload index:pulmonary artery systolic pressure?PASP?,pulmonary vascular resistance?PVR?;left ventricular systolic and diastolic function index:left ventricular end-diastolic volume?LVEDV?,left ventricular stroke volume?LVSV?,left ventricular ejection fraction?LVEF?.Mean Em/em values were calculated according to(E_m/e_m1+E_m/e_m2)/2 of the ventricular septum and lateral wall of mitral annulus,and central venous pressure?CVP?was measured by jugular vein catheterization at the same time.The above parameters were analyzed to understand the early changes of cardiac function after lung cancer resection.Chemical situation.?2?Patients with normal resting cardiopulmonary function and completed cardiopulmonary exercise test?CPET?before operation were divided into two groups according to the difference of cardiopulmonary reserve function,that is,VO2max/kg>15ml/?kg.min?and<15ml/?kg.min?.The changes of cardiac function after operation were compared between the two groups.?3?49 patients with cardiopulmonary symptoms after lung cancer resection were included in this study.The pathological changes included pulmonary infection,pleural effusion,atelectasis,pneumothorax,pulmonary edema and pulmonary embolism.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of bedside pulmonary ultrasound and CT for different pathological changes were compared.?4?Observe the clinical treatment of atelectasis/consolidation guided by pulmonary ultrasound,and record its dynamic changes.?5?Multiplanar method?PEV?=H*S was used to quantify pleural effusion,and to explore the accuracy of this method in quantifying pleural effusion after pneumonectomy.Results:There was no significant difference in preoperative gender,age and weight between wedge resection group?group A?,lobectomy group?group B?and total pneumonectomy group?group C?.Early cardiac function changes after pneumonectomy,some patients had cardiopulmonary complications:?1?right cardiac function changes:right cardiac preload CVP remained stable before and after operation in three groups.Group A:Right ventricular diastolic function decreased 3-6 h and12-24 h after operation,which showed that E_t/e_t was higher than that before operation,and right ventricular systolic function and post-load did not change significantly at all time points.Group B and Group C:Right ventricular systolic function TAPSE decreased and diastolic function decreased 3-6 h,12-24 h,48-96 h after operation:E_t/e_t,Tei index increased,right ventricular afterload PVR and PASP increased,the most significant changes were 48-96h after operation,and the changes in group C were more obvious than those in group B at each period;after144-192h,the parameters in group B recovered to the preoperative level,while the changes in group C remained unchanged.Continued existence.?2?Changes of left ventricular function:There was no significant change in LVEF at different time after operation in the three groups compared with that before operation.Group A:3-6 hours after operation:Left ventricular diastolic function decreased:e_m1 and e_m2 decreased,average E_m/e_m increased,and left ventricular systolic function did not change significantly after operation.Group B and C:3-6 h,12-24 h,48-96 h after operation:left ventricular systolic force index LVEDV,LVSV decreased compared with preoperative,diastolic function decreased:e_m1,e_m2decreased compared with preoperative,average E_m/e_m increased compared with preoperative,the change of parameters in group C was more obvious than that in group B,and the change of parameters in group C lasted until 144-192h after operation,while those in group B recovered close to preoperative level at 144-192h after operation.?3?The right ventricular systolic and diastolic function of VO₂max/kg<15mL/?kg.min?group was lower than that of VO₂max/kg>15 mL/?kg min?group after operation:the decrease of TAPSE,the increase of Et/et and Tei index,the increase of right ventricular afterload PVR and PASP,and the decrease of left ventricular diastolic function:the average increase of Em/em.?4?Bedside pulmonary ultrasound has good consistency with CT.The sensitivity and specificity to pleural effusion,atelectasis and pulmonary edema are close to 100%,but the sensitivity to pneumothorax and pulmonary embolism is slightly lower,but the specificity is higher.?5?Bedside pulmonary ultrasound guidance and dynamic observation of atelectasis/pulmonary consolidation:In 34 cases of atelectasis/pulmonary consolidation,6 cases were restored immediately after increasing PEEP,thoracic drainage and sputum suction,5 cases were restored within 2hours,11 cases were significantly delayed 24 hours after anti-inflammatory treatment,4 cases were delayed 72 hours,and 8 cases were still restored 72 hours later.?6?Quantitative analysis of operative and non-operative pleural effusion by bedside ultrasound showed that there was a significant correlation between the two groups?r=0.799,P<0.01;r=0.826,P<0.01?.Conclusion:?1?Pulmonary wedge resection only resulted in the decrease of left and right cardiac diastolic function in a relatively short time after operation,and recovered to the preoperative level in more than 24 hours.After lobectomy and pneumonectomy,right ventricular systolic and diastolic function decreased,right ventricular afterload increased,left ventricular diastolic function decreased,left ventricular myocardial systolic force decreased.Cardiac function in lobectomy group returned to preoperative level 144-192 hours after operation,while cardiac function changes in pneumonectomy group persisted.?2?The cardiac function of VO₂max/kg<15 ml/?kg min?group before operation was lower than that of VO₂max/kg 15 mL/?kg min?group after operation.The patients with low cardiopulmonary reserve function and risk of complications should be monitored and evaluated carefully after operation.?3?Bedside pulmonary ultrasound has good consistency with CT,which can be used in the preliminary diagnosis of pulmonary infection,pleural effusion,atelectasis,pulmonary edema,pneumothorax and pulmonary embolism after pneumonectomy.It can guide the clinical treatment of atelectasis/pulmonary consolidation,and dynamically observe its effect and prognosis.Ultrasound multiplanar method provides a relatively accurate,simple and reproducible method for early pleural effusion after quantitative pneumonectomy.?4?Bedside cardiopulmonary ultrasound has the advantages of convenience,rapidity,high accuracy,non-invasive and non-radiation.It can rapidly assess and accurately diagnose the common problems of respiratory and circulatory damage,so as to guide clinical practice and reduce the incidence and mortality of adverse reactions.