心脏垂直移位对心室功能和形态的影响  

The Effect of Vertical Displacement of Heart on Ventricular Function and Configuration

作　　者：潘志浩[1] 姜桢[1] 潘翠珍[2] 赵强[3] 

机构地区：[1]复旦大学附属中山医院麻醉科,上海200032 [2]复旦大学附属中山医院心超室,上海200032 [3]复旦大学附属中山医院心外科,上海200032

出　　处：《复旦学报（医学版）》2005年第2期209-211,共3页Fudan University Journal of Medical Sciences

摘　　要：目的　探讨心脏垂直移位时血流动力学改变以及对心室形态 ,功能的影响。方法　健康杂种犬 6条 ,开胸后分别比较正常位置 ,心脏垂直位和心脏垂直加整体头低位时的血流动力学变化 ,心腔压力改变和短轴切面心室形态变化。结果　将心脏处于垂直移位时 ,心输出量 ,每搏量 ,平均动脉压出现显著下降。心脏表面超声显示 :乳头肌中部短轴切面上左、右室的舒张末面积均显著减少。左室舒张末的偏心指数由 0 .99± 0 .2 7升高为1.2 5± 0 .37(P <0 .0 5 )。心脏垂直加头低位时 ,平均动脉压、左室舒张面积和左室舒张末偏心指数可恢复到正常水平。跨室间隔压力差与左室舒张末偏心指数呈显著负相关。结论　心脏垂直移位会产生严重的血流动力学紊乱 ,并伴有心室形态的改变 ;头低位可以部分纠正这些改变。Purpose To study the effects of vertical displacement of heart on the ventricular geometry and function. Methods Six open-chest,anesthetized dogs were studied.Hemodynamic parameters and ventri-cular geometry were compared at normal position,vertical displacement and Trendelenberg position.The relationship of ventricular pressure and geometry was explored,and how preload impacts on the ventricular pressure and geometry were also examined. Results Cardiac output,mean arterial pressure declined dramatically at vertical displacement of heart comparing with normal position.Left and right ventricular end-diastolic cross-sectional area (determined by epicardial echocardiography) significantly decreased (P<0.05).End-diastolic eccentric index of left ventricle increased from (0.99±0.27) to (1.25±0.37) (P<0.05).Subsequent 20 degrees Trendelenburg position recovered mean arterial pressure,end-diastolic cross-sectional area of left ventricles and eccentric index to the baseline.The diastolic transseptal pressure gradient correlated inversely with the eccentric index. Conclusions Vertical displacement of heart could cause significant hemodynamic deterioration and change ventricular geometry.Trendelenburg position can partially reverse these effects.

关 键 词：垂直移位 心脏 心室功能 血流动力学变化 血流动力学紊乱 平均动脉压 左室舒张 动力学改变 头低位 心指数 正常位置 形态变化 心输出量 超声显示 杂种犬 开胸后 每搏量 乳头肌 负相关 压力差 室间隔 切面 面积 

分 类 号：R683.3[医药卫生—骨科学] R654.2[医药卫生—外科学]