左心室舒张功能对慢性心力衰竭病人运动耐量的影响  

The Effect of Left Ventricular Diastolic Dysfunction on the Exercise Capacity in Patients with Chronic Heart Failure.

作　　者：赵玉英[1] 智光[2] 

机构地区：[1]白求恩国际和平医院,石家庄050082 [2]解放军总医院心内科,北京100853

出　　处：《白求恩军医学院学报》2005年第1期16-18,共3页Journal of Bethune Military Medical College

摘　　要：目的　分析影响慢性心力衰竭病人运动耐量的超声心动图指标。方法　选择慢性心力衰竭病人70例,行6min步行试验评价其心肺运动耐量,分析6min步行距离与超声心动图各参数的相关性;选择其中年龄、射血分数匹配的5 0例病人分为限制性充盈组和非限制性充盈组。结果　平均6min行走距离(2 6 0±94 )m。单因素分析显示6min步行距离与年龄、左心室收缩末容量和E/A比值呈负相关,与A峰速度、E峰减速时间和左心室射血分数呈正相关。等级相关分析显示纽约心脏协会心功能分级与6min步行距离之间呈显著负相关,平均6min行走距离,限制性充盈障碍者显著低于非限制性充盈障碍者(2 10±88)m和(2 80±90 )m ,P <0 .0 5 )。多因素线性回归分析二尖瓣A峰速度为6min步行距离的独立影响因素。结论　收缩功能下降比较接近的慢性心力衰竭病人的运动耐量主要受舒张功能的影响,舒张功能受损越严重,6min步行距离越短。应该重视舒张功能对慢性心力衰竭病人运动耐量的影响。Objective To determine the effect of left ventricular diastolic dysfunction on the exercise capacity in patients with chronic heart failure. Methods Seventy consecutive patients (mean age, 53± 14 years) with heart failure (New York Heart Association class, II to IV) who had received echocardiographic diagnoses of dilated or ischemic cardiomyopathy were studied, echocardiography were performed to measure the parameters of left ventricle function.All patients also underwent cardiopulmonary exercise using 6-minute walk test. Results Advanced NYHA class was associated with shorter walk distances.A positive correlation was found between 6-minute walk distances and A wave velocity,DT and LV EF,a negative correlation with age,left ventricular end-systolic Volume and E/A ratio.There was no correlation of walk distance with heart rate,blood pressure.Stepwise regression analysis revealed that the late LV filling velocity were the only independent predictors for cardiopulmonary exercise capacity.Compared to patients with non-restrictive filling pattern,ptients with restrictive filling pattern had shorter walk diatances(210 m±88 m vs 280 m±90 m,P<0.05). Conclusion Left ventricle diastolic function is a major determinant of exercise capacity of patients with chronic heart failure.

关 键 词：6min步行试验 慢性心力衰竭 舒张功能 

分 类 号：R541.6[医药卫生—心血管疾病] R540.47[医药卫生—内科学]