关于右心心肌力学测定方法的研究  

Study on methods of myocardium mechanics measurement for right heart

作　　者：朱宝玉[1,2] 陈光瑾[1,2] 杜文彬[1,2] 刘恩桥[1,2] 

机构地区：[1]天津医科大学总医院内科 [2]天津医科大学病生理教研室

出　　处：《中国危重病急救医学》1997年第8期472-474,共3页Chinese Critical Care Medicine

基　　金：卫生部七五攻关课题

摘　　要：目的：探讨右心心肌力学测定方法并对慢性阻塞性肺疾病（ＣＯＰＤ）和肺原性心脏病（肺心病）患者右心室心肌舒缩性能进行定量化估价。方法：对ＣＯＰＤ和肺心病各２６例患者行右心导管检查，记录心电图、右房压、右室压和肺动脉压，测定右室内压上升（或下降）最大速率（±ｄｐ／ｄｔｍａｘ）、零负荷时心肌收缩成分缩、舒速度（±Ｖｍａｘ）、心室压力１．３３ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）时室内压上升（或下降）速率（±Ｖｃｅ１０）和等容舒张期心室内压下降的时间常数（Ｔ值）。结果：肺心病患者Ｖｍａｘ和Ｔ值均低于ＣＯＰＤ患者；２组间Ｖｍａｘ、－ｄｐ／ｄｔｍａｘ均有高度显著性差异（Ｐ均＜０．０１），ｄｐ／ｄｔｍａｘ、－Ｖｃｅ１０也均有显著性差异（Ｐ均＜０．０５）；－Ｖｍａｘ、Ｔ值均无显著性差异（Ｐ均＞０．０５）。结论：Ｖｍａｘ是一个既能反映心肌收缩能力，而又不受前后负荷影响的心肌力学指标，而其它指标如±ｄｐ／ｄｔ、±Ｖｃｅ１０、Ｔ值均受前后负荷的影响。Objective:To investigate the methods of myocardium mechanics measurement for right heart,and evaluate estimation of diastolic and systolic function of right ventricular myocardium in patients with chronic obstructive pulmonary disease (COPD) and cor pulmonale.Methods:Fiftytwo patients with COPD (n=26) and cor pulmonale (n=26) were examined by right cardiac catheterization.The indices of electrocardiogram,right atrium pressure,right ventricular pressure,pulmonic pressure were recorded.The±dp/dtmax,±Vmax,±Vce10 and T values were calculated.Results:Vmax and T values were markedly low in patients with cor pulmonale compared with those with COPD.There were significant differences in Vmax, -dp/dtmax, dp/dt as well as -Vce10 between the two groups ( P <0 05～0 01),but no marked differences inVmax and T values (all P >0 05) were found in this study.Conclusions:The Vmax is an useful parameter of myocardial mechanics,which can reflect myocardial contractility and not be affected by preload and postload.But the other indices,such as ±dp/dt,±Vce10 and T values,may be affected by preload and postload of the ventricle.

关 键 词：心肌力学 肺心病 慢性阻塞性肺病 

分 类 号：R541.502[医药卫生—心血管疾病]