踏车运动试验评价高血压患者左室舒张功能变化

发布时间：2018-04-09 15:35

本文选题：运动负荷超声心动图　切入点：高血压　出处：《昆明医科大学》2017年硕士论文

【摘要】：[目的]利用运动负荷超声心动图(exercise stress echocardiography,ESE)对高血压病患者和正常人左室舒张功能进行评价,探讨运动对左室舒张功能的影响。[资料与方法]入选对象为2016年8月至2017年2月于昆明医科大学第一附属医院心内科就诊的原发性高血压患者20例,其中男性12例,女性8例,年龄(52±7.28)岁,患者自诉有胸闷、气短。超声心动图检查有左心房内径增大或(和)左室壁增厚,左心室内径正常,静息状态下左室收缩功能正常,舒张功能受损。另选20例无心血管疾病史正常人进行对照;其中男9例,女11例,年龄(49.8±5.44)岁;排除标准:心脏瓣膜疾病、冠心病、心包疾病、先天性心脏病、肥厚型心肌病、糖尿病、高脂血症及伴肺、肝、肾、脑等严重器质性疾病及下肢功能障碍、肥胖体型不适合踏车运动试验者;所选受检者均为窦性心律,心率为60-90次/分,年龄60岁。受检者均行常规超声心动图检查,评估心脏的结构及收缩、舒张功能。对正常对照组及高血压组患者进行仰卧位脚踏车运动试验,连接心电监护,监测受检者心率、血压,以受检者达次极量心率(190-年龄)次/分,或出现严重心律失常,或受检者收缩压≥220mmHg或舒张压≥120mmHg或疲乏时终止运动。在停止运动即刻进行超声心动图检查,再次评估运动终止即刻受检者心脏结构及收缩、舒张功能;待受检者运动后休息30分钟再次行超声心动图检查评估受检者心脏结构及收缩、舒张功能。采集受检者运动前、运动终止即刻、运动后休息30分钟心脏二维、M型、脉冲多普勒及组织多普勒静态图像并储存,记录两组受检者运动前、运动终止即刻及运动后休息30分钟左室舒张功能相关指标,利用SPSS22.0统计软件分别对两组受检者之间及每组受检者运动前、运动终止即刻、运动后休息30分钟左室舒张功能参数的变化进行比较分析,探讨运动与左室舒张功能的关系。[结果]基础状态下高血压组与正常对照组左室舒张功能指标E、A、Em、Am、E/Em、E/A、Em/Am参数组间比较有明显差异。组内比较高血压组患者运动终止即刻较运动前及运动后休息30分钟左室舒张功能指标E、A、Em、Am、E/Em比值升高,E/A、Em/Am降低,运动前与运动后休息30分钟比较舒张功能指标E、A、Em、Am、E/Em、E/A、Em/Am无明显变化;正常对照组运动终止即刻较运动前及运动后休息30分钟左室舒张功能指标E、A、Em、Am同步增高,E/A、Em/Am、E/Em比值无明显变化。[结论]高血压病患者次极量负荷运动会加重已轻度受损的左室舒张功能,而对正常受检者的左室舒张功能无明显影响。
[Abstract]:[Objective] the use of exercise echocardiography (exercise stress, echocardiography, ESE) to evaluate the normal left ventricular diastolic function in patients with hypertension and explore]. Materials and methods, effects of exercise on left ventricular diastolic function selected from August 2016 to February 2017 in the First Affiliated Hospital of Kunming Medical University, Department of Cardiology, 20 patients with essential hypertension cases, there were 12 males, 8 females, age (52 + 7.28) years old, patients reported chest tightness, shortness of breath. Echocardiography has an enlarged left atrium or (and) left ventricular wall thickness, left ventricular diameter, left ventricular systolic function in normal resting state, impaired diastolic function in 20. With no cardiovascular disease history of normal controls; the male 9 cases, female 11 cases, age (49.8 + 5.44) years; exclusion criteria: valvular heart disease, coronary heart disease, pericardial disease, congenital heart disease, hypertrophic cardiomyopathy , diabetes, hyperlipidemia and liver, kidney, and lung, brain and other serious organic disease and lower extremity dysfunction, obesity is not suitable for the treadmill exercise test; the selected subjects were in sinus rhythm, heart rate was 60-90 beats per minute, 60 years of age. The subjects were examined by echocardiography the structure, and contraction of cardiac diastolic function assessment. Supine bicycle exercise test in the normal control group and hypertension group were connected, ECG monitoring, monitoring subjects heart rate, blood pressure, the subjects of submaximal heart rate (190- / min, age) or serious heart arrhythmia, or subjects contraction pressure 220mmHg or diastolic blood pressure more than 120mmHg or tired. The termination of the movement in stop motion immediately by echocardiography evaluation subjects immediately terminate the movement of cardiac structure and diastolic function to shrink again; the subjects after exercise and rest for 30 minutes again by echocardiography Figure evaluation subjects cardiac structure and systolic, diastolic function. Collected before exercise, immediately terminate the movement, rest for 30 minutes after exercise heart 2D, M, pulse Doppler and tissue Doppler image recording and storage, two groups of subjects before exercise, exercise and stop immediately after exercise and rest 30 minutes of left ventricular diastolic function indexes between subjects in the two groups respectively using SPSS22.0 statistical software, and each group of subjects before exercise, immediately after exercise termination of movement, change and rest for 30 minutes of left ventricular diastolic function parameters were compared and analyzed, explore the movement and left ventricular diastolic function. Results: the basic condition hypertension group and normal control group left ventricular diastolic function indexes of E, A, Em, Am, E/Em, E/A, Em/Am parameters were compared between groups had significant difference. Group compared with hypertension group were compared with those before exercise and immediately terminate the sports movement after rest for 30 minutes The left ventricular diastolic function indexes of E, A, Em, Am, E/A, E/Em ratio increased, Em/Am decreased, before and after the exercise and rest for 30 minutes compared with the diastolic function indexes of E, A, Em, Am, E/Em, E/A, Em/Am had no obvious change; the normal control group compared with the immediate termination of exercise pre exercise and post exercise Hugh 30 minutes of left ventricular diastolic function indexes of E, A, Em, Am, E/A, Em/Am, synchronization increased, E/Em ratio did not change significantly. Conclusion patients with hypertension in submaximal load exercise will increase the left ventricular diastolic function was mildly impaired, and the left ventricular diastolic function in normal subjects had no significant impact.

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1;R540.45

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