脉冲多普勒超声心动图对心室程控刺激诱发室性期前收缩的血流动力学定量研究  

Study on Hemodynamics of Ventricular Premature Depolarization Induced by Programed Stimulization with Pulsed Doppler Echocardiography

作　　者：胡燕燕[1] 张运[1] 黎莉[1] 张丽[1] 李方[1] 张薇[1] 

机构地区：[1]山东医科大学附属医院心内科

出　　处：《中华超声影像学杂志》1998年第5期272-274,共3页Chinese Journal of Ultrasonography

摘　　要：为探讨室性期前收缩对心脏排血和充盈的血流动力学变化和影响，对３０例做电生理检查的患者，利用程控刺激仪诱发室性期前收缩以产生不同提前间期的室性期前收缩，同时运用脉冲多普勒超声技术记录二尖瓣口及主动脉瓣口血流频谱，分别测量主动脉瓣口和二尖瓣口的流速积分（ＡＶＩ，ＭＶＩ）。同时记录动脉内压力曲线。结果显示：室性期前收缩时ＡＶＩ和ＭＶＩ（ＥＡＶＩ和ＥＭＶＩ）明显低于正常心动周期时ＡＶＩ和ＭＶＩ（ＮＡＶＩ和ＮＭＶＩ）Ｐ值均＜０．００１，代偿的ＡＶＩ和ＭＶＩ（ＰＡＶＩ和ＰＭＶＩ）分别高于ＮＡＶＩ和ＮＭＶＩ，Ｐ值均＜０．００１，但仅能代偿２５％和２３％，每位患者室早提前指数（Ｔ－Ｒ′／Ｒ－Ｒ）与室早排血比值（ＥＡＶＩ／ＮＡＶＩ）及室早充盈比值（ＥＭＶＩ／ＮＭＶＩ）呈良好相关，当Ｔ－Ｒ′／Ｒ－Ｒ＜０．２２时，ＥＡＶＩ／ＮＡＶＩ降至０，即无血液搏出。随着提前指数（Ｔ－Ｒ′／Ｒ－Ｒ）的不断降低，早搏时的收缩，舒张压（ＥＳＢＰ和ＥＤＢＰ）逐渐降低，当Ｔ－Ｒ′／Ｒ－Ｒ＜０．２２时动脉血压为０。本研究表明，脉冲多普勒超声可作为研究和评估室早血液动力学变化的非创性诊断技术。室早时心搏量和充盈量明显下降，室早后心搏量和充盈量代偿不足，室?Limited data are available on hemodynamic during ventricular premature depolarization(VPD). The authors used pulsed Doppler to assess transmitral flow from mitral tip and transaortic flow from aortic tip at apical 4 and 5 chamber views in 30 patients with VPD induced by programed stimulization, all without organic heart diseases. Transmitral and transaortic flow velocity integral (MVI, AVI) were measured in sinus beat before(NMVI, NAVI)and after VPD (PMVI, PAVI)as well as during VPD (EMVI, EAVI). The intraartery blood presures were also measured before(NSBP, NDBP) and after(PSBP, PDBP), as well as during VPD(ESBP,EDBP). LV filling ratio(LVFR)of VPD beast were calculated by EMVI/NMVI, and LV output ratio(LVOR)were calculated by EAVI/NAVI. EAVI adn ENVI were all significantly lower than NAVI and NMVI respectively (P<0.001). PAVI and PMVI were all significantly higher than NAVI and NMVI(P<0.001). but only compensated 25% and 23%, respectively. The prematuity index (PI=interval from peak of T of SB to R of VPD/R R interval of SB, i.e., T R′/R R)corrlated. well with LVOR and LVFR. when T R`/R R<0.22, EVAI/NAVI decreased to 0, that is, no blood flow output. Along with the decrease of T R`/R R, ESBP and EDBP decreased gradually to 0, when T R`/R R= 0.22 . Conclusions: 1. The AVI and MVI decreas significantly during VPD. The PAVI and PMVI increase, but the compensation are not complete. 2. When T R`/R R<0.22, EAVI/NAVI decrease to 0, VPD should be paid attention to.

关 键 词：室性期前收缩 超声心动描记术 血流动力学 

分 类 号：R540.45[医药卫生—心血管疾病]