缺血性心脏病肺动脉压的相关分析

发布时间：2018-04-12 14:53

本文选题：心功能不全 + 二尖瓣反流速度　；参考：《山东大学》2015年硕士论文

【摘要】：研究背景：心力衰竭(简称心衰)是各种心脏病进展的严重阶段。目前为止临床医生评价病人心功能仍然依靠临床症状、体征、化验指标及超声资料等有机结合判断。射血分数(LVEF)是评价左室收缩功能的重要指标。临床工作中常常发现,有些心力衰竭患者射血分数己明显下降,甚至达30%以下,却无明显气短或呼吸困难等症状,尚能进行适当活动；同时也观察到部分心衰患者,虽然射血分数正常,但胸闷气短、呼吸困难己非常明显。除了左室收缩功能以外,病人的心功能状态还与左室舒张功能及肺动脉压有关。目的：本实验旨在观察缺血性心脏病患者心功能状态与肺动脉压力的相关性,重点探讨肺动脉压力与二尖瓣反流速度、心脏各腔径大小、左室射血分数及血浆N端脑钠肽前体之间的关系,进而为指导临床医生早期预测肺动脉压,采取措施,防止肺动脉升高,改善患者生活质量。方法：连续入选2013年12月至2014年8月因缺血性心脏病合并心力衰竭入住东阿县人民医院心内科的住院患者118例,入院当天行超声心动检查,于胸骨旁左室长轴切面舒张末期垂直于二尖瓣踺索中段平面测量左室前后径(单位：毫米),右心室前后径,同时于胸骨旁左室长轴切面收缩末期测量左房前后径(单位：毫米)、于心尖四腔切面应用simpson s法测量EF值,同时测量二尖瓣反流速度(单位：厘米\秒)、三尖瓣反流速度,依据三尖瓣反流压力阶差估测肺动脉收缩压(单位：毫米汞柱)。按照美国纽约心脏病学会(New York Heart Association NYHA)心功能分级标准及左心室射血分数将病人分为三组：A组EF正常+NYHAⅠ～Ⅱ级,共36人；B组EF降低+NYHA Ⅰ～Ⅱ级,共34人；C组EF降低+NYHA Ⅲ～Ⅳ级,共48人。血液标本化验N端脑钠肽前体(NT-proBNP单位：pg/ml)。采用统计方法,统计方法采用卡方检验及配对t检验、相关分析,运用SPSS17.0统计软件对实验结果进行统计分析。结果：在缺血性心脏病发生心力衰竭的患者中,C组射血分数降低、心功能Ⅲ～Ⅳ级的一组患者,肺动脉压力力明显升高；A组EF正常心功能Ⅰ-Ⅱ级和B组EF降低心功能Ⅰ-Ⅱ级2组患者肺动脉无明显升高。进一步对肺动脉高压一组(C组)进行肺动脉压相关因素分析,发现患者肺动脉压力与左房前后径呈正相关,与左室前后径呈正相关,与右心室前后径呈正相关,与二尖瓣反流速度呈正相关；N端脑钠肽呈正相关,与射血分数呈负相关。三组间药物应用差异无统计学意义。结论：在缺血性心脏病发生心力衰竭患者中,患者临床心功能状态的下降与肺动脉压力升高具有相关性；患者肺动脉压力与左房内径、左心室舒张末内径、右心室舒张末内径、N端脑钠肽及二尖瓣反流速度均呈正相关,与左室射血分数呈负相关,以上指标可作为患者肺动脉压力升高的预判指标,临床医生可在肺动脉压升高前尽早采取再灌注或血管重建措施,防止肺动脉升高,改善患者生活质量。
[Abstract]:Background: heart failure (CHF) is a serious stage of various heart diseases. So far the clinician patient assessment of heart function still depends on the clinical symptoms, signs, laboratory tests and ultrasound data combination judgment. Ejection fraction (LVEF) is an important index for evaluation of left ventricular systolic function. Often found in clinical work. Some heart failure patients with ejection fraction has decreased significantly, even less than 30%, but no obvious symptoms such as shortness of breath or difficulty breathing, proper activity is also observed; some patients with heart failure, although the normal ejection fraction, but the shortness of breath, dyspnea is very obvious. In addition to the left ventricular systolic function, heart function the status of the patient with left ventricular diastolic function and pulmonary artery pressure. Objective: the purpose of this experiment is to observe the correlation between heart function in patients with ischemic heart disease and pulmonary artery pressure, weight Discussion on pulmonary artery pressure and mitral regurgitation velocity, the heart of the cavity size, N ejection fraction and left ventricular end of plasma brain natriuretic peptide in the relationship between so as to guide clinicians in early prediction of pulmonary artery pressure, to take measures to prevent the pulmonary artery increased, improve the quality of life of the patients. Methods: a total of December 2013 to August 2014 due to the Department of Cardiology of Dong'e County People's Hospital in heart failure combined with ischemic heart disease in 118 cases, echocardiography was performed on the day of admission, in the parasternal long axis plane perpendicular to the end diastolic mitral valve - section plane cable measurement of left ventricular diameter (mm), right ventricular diameter, at the same time before and after the sternum beside the long axis view of left ventricle systolic measurement of left atrial diameter (mm), to measure the EF apical four chamber view using Simpson s method, simultaneous measurement of mitral regurgitation velocity (unit: cm. Three), tricuspid regurgitation rate, on the basis of the three tricuspid regurgitation gradient estimation of pulmonary artery systolic pressure (mm Hg). According to the New York Heart Association (New York Heart Association NYHA) standard classification of cardiac function and left ventricular ejection fraction of patients were divided into three groups: group A EF normal +NYHA I-II, 36; B group decreased EF +NYHA I - II, 34; C group decreased EF +NYHA III ~ IV, a total of 48 people. The blood specimen of N terminal pro brain natriuretic peptide (NT-proBNP, pg/ml). Using statistical methods, statistical methods using card square test and paired t test, correlation analysis, using SPSS17.0 statistical software for statistical analysis of the experimental results. Results: the occurrence of heart failure in ischemic heart disease patients, C group reduced ejection fraction, cardiac function in a group of patients with grade III ~ IV, pulmonary artery pressure increased significantly; A group EF normal heart the function of And B group EF decreased heart function I-II 2 groups of patients with pulmonary artery were not significantly increased. The pulmonary hypertension group (C group) to analyze related factors of pulmonary arterial pressure, and found that patients with pulmonary artery pressure and left atrial diameter was positively related to size was positively correlated with left ventricular diameter, were positively correlated and right ventricular, and mitral regurgitation velocity were positively correlated; N terminal brain natriuretic peptide was positively related to a negative correlation with the ejection fraction. There was no significant difference between the three groups of drug application. Conclusion: in the event of heart failure in patients with ischemic heart disease, pulmonary arterial pressure decreased with the clinical heart function state has increased correlation; diameter of pulmonary arterial pressure in patients with left atrial and left ventricular end diastolic diameter, right ventricular end diastolic diameter, N terminal brain natriuretic peptide and mitral regurgitation rate were positively correlated, negatively correlated with left ventricular ejection fraction, the above can be used as indicators of patients The pulmonary artery pressure increased to predict the index, clinicians can take early reperfusion or revascularization in elevation of pulmonary artery pressure, pulmonary artery to prevent the rise, improve the life quality of patients.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.6

【参考文献】