等长运动对正常人、冠心病患者左室心功能的影响  

Assessment of left ventricular function in patients with coronary heart disease by isometric handgrip exercise

作　　者：杨顺方[1] 俞志昌 诸惠萍 倪幼芳[3] 谢文辉 程建凡 马寄晓[4] 

机构地区：[1]上海胸科医院核医学科,上海200030 [2]上海胸科医院心导管室,上海200030 [3]上海胸科医院心内科,上海200030 [4]上海市第六人民医院

出　　处：《心脏杂志》2000年第6期446-449,共4页Chinese Heart Journal

摘　　要：目的 :通过核素心血池显像测定静息状态和等长运动后正常人、冠心病患者左室心功能指标的变化 ,探讨等长运动对冠心病诊断的临床价值。方法 :45例正常人、10 0例冠心病患者常规核素平衡法门电路心血池显像测定左室心功能。在静息状态下采集后 ,保持探头和患者体位不变 ,双手握力 5～ 10 min并同时进行采集从而获得静息和握力运动状态下两组血流动力学指标和时间—放射性曲线。11例正常人和 10 0例冠心病患者行冠状动脉及左心室造影 ,两项检查间隔不超过两周。运用 SPSS9.0统计软件进行 t检验和直线相关分析。结果 :左室射血分数(L VEF)、高峰充盈率 (PFR)、左室舒张末期容积 (L VEDV )、左室收缩末期容积 (L VESV )和心率 (HR)在静息(Rest)状态下 ,对照组和冠心病组分别为 (5 2± 9) % vs(4 5± 9% ) ,P<0 .0 1;2 .7± 0 .8EDV/s vs2 .0± 0 .8EDV/s,P<0 .0 1;1.33± 0 .12 vs 1.2 8± 0 .11,P <0 .0 5 ;0 .6 3± 0 .10 vs 0 .0 7± 0 .0 8,P<0 .0 1;7.0± 10 m in- 1 vs 6 9± 9min- 1 ,P>0 .0 5。在等长握力运动 (Stress)状态下 ,对照组和冠心病组分别为 (5 6± 10 ) % vs(4 2± 10 ) % ,P<0 .0 1;3.1± 0 .8EDV/s vs 1.8± 0 .7EDV/s.P<0 .0 1;1.35± 0 .14vs 1.2 5± 0 .12 ,P<0 .0 1;0 .6 0± 0 .AIM:To assess the influence of isometric handgrip exercise on left ventricular function by radionuclide angiography (RA) in patients with coronary heart disease (CHD). METHODS:Using gated equilibrium radionuclide angiography,variables of left ventricular function were analyzed at rest and during supine handgrip exercise for 5~10 min in 45 normal control subjects and 100 consecutive CHD patients (at least 1 vessel with greater than or equal to 50% diameter narrowing) who were receiving therapy in a university teaching hospital setting. RESULTS:At rest,the left ventricular ejection fraction (LVEF),peak filling rate (PFR),end diastolic volume (EDV),end systolic volume (ESV) and heart rate (HR) were reduced in subjects with CHD (45±9)%,2.0±0.8 EDV/s,1.28±0.11, 0.07±0.08,69±9 min -1 ,as compared with those of the controls (52±9)%, P <0.01,2.7±0.8 EDV/s, P <0.01,1.33±0.12, P <0.05;0.63±0.10, P <0.01;70±10 min -1 , P >0.05. At handgrip exercise using both hands,the indexes were reduct in CHD patients(42±10)%, 1.83±0.71 EDV/s,1.25±0.12,0.73±0.88,79±12 min -1 , as compared with those of the controls (56±10)%, P <0.01;3.1±0.8 (EDV/s), P <0.01;1.35±0.14, P <0.01;0.60±0.12, P <0.01;83±13 min -1 , P >0.05. LVEF,PFR and EDV were related to LVEDP by arteriography, both at rest ( r= -0.279,P=0.005; r =-0.271, P =0.006; r =-0.221, P =0.027 respectively)and during handgrip( r =-0.365, P <0.01; r =-0.344, P <0.01; r =-0.313, P =0.002 respectively). These finding suggest that alterations in LV function during handgrip are importent determinants of clinical evaluation in patient with CHD. CONCLUSION:The handgrip exercise increased not only afterload but also preload,but the main increment is in afterload. RA at rest and during handgrip exercise combined with pressure volume loops is an accurate,effective method to evaluate CHD.

关 键 词：等长运动 心脏功能试验 放射性核素显像 冠心病 

分 类 号：R541.402[医药卫生—心血管疾病]