心功能不同时期患者的无创血流动力学检测分析  

Analysis of noninvasive hemodynamics in patients with cardiac disfunction during different periods

作　　者：王卓清 李永豪[2] 郭元芳[2] 李美慧[2] 龚积艳[2] 王俊华[2] 

机构地区：[1]河北北方学院,河北张家口075000 [2]空军总医院心内科,北京100142

出　　处：《军事医学》2017年第8期675-679,共5页Military Medical Sciences

摘　　要：目的观察慢性心力衰竭(CHF)不同进展阶段患者无创血流动力学指标的变化规律,探讨其相关指标检测的临床实用意义。方法选取空军总医院2014年3月~2016年10月心脏中心住院的119例患者,按照美国心脏病学学会/美国心脏病协会(American College of Cardiology/American Heart Association,ACC/AHA)心衰进展分期标准将其分为A、B、C期,A期即前心衰阶段(A组),B期即前心衰临床阶段(B组),C期即临床心衰阶段(C组)。另选同期来院健康体检者39例作为正常对照组(O组)。收集患者临床资料,并采集外周静脉血,检测血清B型利钠肽(BNP)水平,行心脏超声,记录左心室射血分数(LVEF)值,同时行无创血流动力学检测,记录无创血流动力学心功能指标,包括心搏出量(SV)、心输出量(CO)、心脏指数(CI)、室缩波波幅(C波波幅,C);心缩力指数(HI)、收缩功能指数(Q-B/B-X);肺动脉楔压(PCWP)、左心室舒张末压(LVEDP);主动脉顺应性(AC)、总外周阻力(TPR)。比较分析CHF不同进展阶段无创血流动力学指标及BNP、LVEF的变化。结果与对照组相比,A^C 3组无创血流动力学C、SV、CO、CI、HI、AC指标值降低(P<0.05),Q-B/B-X、PCWP、LVEDP指标值升高(P<0.05);心衰不同进展阶段各组进一步两两比较显示,除CO、AC在A、B组之间无差异外,其余指标差异均具有统计学意义(P<0.05);C、SV、CO、CI、HI、AC随心衰不同进展阶段而降低(P<0.05),而C、CI、HI降低更显著;Q-B/B-X、PCWP、LVEDP随心衰不同进展阶段而增高(P<0.05),而Q-B/B-X增高更显著。BNP在C组比正常对照组、A组和B组明显升高(P<0.05),但A、B组之间,A、B组和O组之间有升高的趋势,无统计学意义(P>0.05);LVEF在C组较O组、A组和B组明显降低(P<0.05),在A、B组之间,A、B和O组之间有下降的趋势,无统计学意义(P>0.05)。经相关性分析无创血流动力学指标C、SV、CO、CI、HI、AC、LVEF均与心衰不同进展阶段呈负相关,Q-B/B-X、PCWP、LVEDP、TObjective To observe the changes in noninvasive hemodynamic parameters in patients with chronic heart failure（ CHF） at different stages of development,and to explore the clinical significance of related parameters. Methods A total of 119 patients who had been hospitalized in the Heart Center of our hospital between March 2014 and Orctober2016 were divided into phases A,B,and C according to the ACC/AHA Progression Criteria for Chronic Heart failure.Phase A was pre heart failure group A,phase B was pre clinical heart failure stage group B,and phase C was the clinical stage of heart failure group C. Meanwhile,39 healthy people in our hospital were chosen as group O. Their clinical data,serum BNP levels and LVEF values were collected,the noninvasive hemodynamic indexes of heart function were recorded by the noninvasive cardiac function detection system,including stroke volume（ SV）,cardiac output（ CO）,cardiac index（ CI）,systolic C wave amplitude,cardiac contractility index（ HI）,systolic function of heart contractility index（ Q-B/B-X）,pulmonary artery wedge pressure（ PCWP）,left ventricular end diastolic pressure（ LVEDP）,aortic compliance（ AC） and total peripheral resistance（ TPR）. Comparative analysis of noninvasive hemodynamic indexes and changes in BNP and LVEF in different stages of CHF was conducted. Results The levels of C,SV,CO,CI,AC and HI in groups A,B and C were lower than those in control group（ P 0. 05）,while Q-B/B-X,PCWP,LVEDP,and TPR were higher than those in the control group（ P 0. 05）. C,CI,and HI decreased more significantly,but Q-B/B-X,PCWP,and LVEDP increased with the development of heart failure（ P 0. 05）. BNP was significantly higher in group C than in normal control group（ P 0. 05）,but there was no significant difference between group A and B. LVEF in group C was significantly lower than that in group O（ P 0. 05）. There were negative correlations between SV,CO,CI,C,HI,AC and LVEF at different stages of heart failure,but there were positive

关 键 词：心力衰竭 心功能 无创血流动力学 

分 类 号：R541.6[医药卫生—心血管疾病]