逆转左心室肥厚──改善高血压病患者预后的关键(附101例尸检资料)  

REVERSAL OF LEFT VENTRICULAR HYPERTROPHY (LVH)──PATHO-CLINICAL ANALYSIS OF 101 CASES

作　　者：丁自超[1] 韦立新[2] 游联壁[2] 

机构地区：[1]中国人民解放军总医院急诊科,北京100853 [2]中国人民解放军总医院病理科,北京100853

出　　处：《急诊医学》1998年第1期6-11,共6页

摘　　要：本文探讨左心室肥厚（LVH）及其逆转对高血压病（HT）患者预后的意义。收集以HT为主要或重要致死原因的101例临床尸检资料，测定其全心重量，左心室前壁、室间隔及右心室厚度，LVH检出率为99．01％（全心重：男456．72±84．17g，女452．55±101．30g，左心室前壁厚度1．55±0．31cm），并分析其影响因素。合并LVH者病理生理学转归中，左心衰竭发生率居首位（占88％）；呼吸衰竭与肺水肿占第2位（74％与66％）；脑卒中、心肌梗死、全心衰竭与心源性休克居第3位；肾衰、脑水肿、脑疝、严重心律失常、猝死与骤停居第4位（位间P值＜0．05～0．01）。以变量聚类方法，将诸项转归分为4集群（Cluster）。Custerl左心衰竭、肺水肿、呼吸衰竭、心肌梗死、全心衰竭、心源性休克，CLuster2猝死，Cluster3严重心律失常、骤停及肾衰，Cluster4脑卒中、脑水肿及脑值。资料表明，LVH对HT患者的转归具有潜在的致命性危险。逆转LVH是改善HT患者预后的关键。本研究佐证对合并LVH者以早期诊断及早期有效的治疗是逆转左心室肥厚的必要措施。To investigate & study the clinical significance of LVH & its reversal to the prognosis of hypertension patients, 101 cases, whose fatal or principle fatal cause was hypertension, were collected. The detection rate of left ventricular hypertrophy (LVH) in this study was 99. 01 %, with total cardiac weight 456. 72 ± 84. 17g in male,452. 55± 101. 30g in female & thickness of anterior LV wall 1. 55± 0. 31cm. Pathophysiology sequlea of LVH cases, in the lst place was left ventricular failure (LVH) 88%, secondly, respiratory failure (RPF) & pulmonary edema (PE) (74% & 66%), thirdly, cerebrovascular accident (CVA), myocardial infarction (MI), pancardiac failure (PCF), cardiogenic shock (CS), fourthly, renal failure (RNF), cerebral edema (CE), hernia of brain (BH), severe arrhythmias (SA), sudden death (SD), & cardiac arrest (CA), between the places p<0.05-0. 01. By variable clustering method, the pathophysiological sequelae were divided into 4 clusters: Cluster 1: LVF, PE, RPF, MI, PCF, CS, C1uster 2: SD, Cluster 3: SA, CA, RNF, and Cluster 4: CVA, BE, BH. The information proved that LVH was a risk factor with severe sequelae to hypertensive patients & reversal of LVH was the key of improving their prognosis. Early diagnosis, early and effective therapy of LVH was the core of reversal.

关 键 词：高血压 左心室肥厚 预后 

分 类 号：R544.107[医药卫生—心血管疾病]