心功能不同时期患者的无创血流动力学检测分析

发布时间：2018-08-16 14:21

【摘要】：心力衰竭(HF)是一种慢性进展性疾病,一旦起病,即使没有新的心肌损伤,自身仍不断的在进展,预后差。虽然药物及器件治疗不断改进的今天,但仍然难以使其逆转。这样,其早期预防、早期治疗就显得尤为重要。2001年美国心脏病学会(ACC)/美国心脏病协会(AHA)根据HF病理生理的发生发展过程将其分为四期,强调心衰的不可逆进展过程及早期预防、早期治疗的重要性。预防从A期(前心衰阶段)的高危险因素疾病进展到B期,即出现心脏结构的改变;预防B期进展到C期,即出现心衰临床症状。而A、B期属于亚临床心衰期,主要是高血压病与冠心病,这些疾病对心功能的损伤直至出现临床心衰症状的过程比较漫长,临床上也缺乏能够用于心衰进展过程中心功能评价的客观指标。本研究通过观察AHA/ACC心衰分期标准各期心衰患者的无创血流动力学指标及常规用的评估心功能指标B型利钠肽(BNP)、左心室射血分数(LVEF)的变化规律,探讨无创血流动力学相关指标在慢性心力衰竭(CHF)发生发展过程中的临床实用意义,其变化趋势是否与心衰不同发展阶段具有一致性,并筛选出适用于心衰早期进展过程中评估心功能的客观指标,为早期对病情的评估以及防治措施提供科学依据。选取2014.3—2016.10空军总医院心脏中心因慢性心力衰竭及其高危险因素疾病住院的患者共119例,其中男性76例,女性43例,年龄64±14.9岁。每位患者根据ACC/AHA心衰进展分期标准进行分期,然后将A期(前心衰阶段)归为A组,B期(前临床心衰阶段)为B组;C期(临床心衰阶段)为C组。另选同期我院39例健康体检者作为正常对照组(记为O组)。再将A组患者根据不同的危险因素疾病分为冠心病亚组(记为A1组)和高血压亚组(记为A2组)。收集患者临床资料及相关检查,行无创血流动力学检查,记录无创血流动力学指标,包括心搏出量(SV)、心输出量(CO)、心脏指数(CI)、C波波幅、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)。并记录BNP血清水平、LVEF值做参考。比较分析各组无创血流动力学相关指标、BNP、LVEF的变化,通过统计学分析这些指标变化趋势与心衰不同发展阶段的关系,并分别绘制出早期阶段的受试者工作特征曲线(ROC曲线),筛选出适用于心衰早期进展过程中评估心功能的客观指标。无创血流动力学指标SV、CO、CI、C波波幅、HI、Q-B/B-X、PCWP、LVEDP、AC、TPR、BNP、LVEF均与心衰不同发展阶段具有显著的线性相关性(P全部0.05);经两两比较C、CI、HI在心衰早期阶段显著降低,Q-B/B-X显著升高(P0.05),而无创血流动力学其余指标、BNP、LVEF值在心衰早期阶段变化不显著(P0.05);接受受试者工作特征曲线分析证明HI、Q-B/B-X敏感性、特异性均较其他指标高,曲线下面积均优于其他指标。无创血流动力学相关指标的变化与心衰不同发展阶段具有一致性,慢性心力衰竭患者在A期即高危险因素期出现血流动力学的变化,心功能就受到一定程度的影响。无创血流动力学检测指标HI、Q-B/B-X可为临床评估心衰早期心功能提供客观参考指标。
[Abstract]:Heart failure (HF) is a chronic progressive disease that is progressing and has a poor prognosis without new myocardial damage. Drug and device therapies continue to improve today, but it is still difficult to reverse. Thus, early prevention and treatment are particularly important. The American College of Cardiology (ACC)/2001 The American Heart Association (AHA) divides HF pathophysiology into four stages, emphasizing the irreversible progression of HF and the importance of early prevention and treatment. Phases A and B belong to subclinical heart failure, mainly hypertension and coronary heart disease. These diseases have a long process of impairing cardiac function until clinical heart failure symptoms appear. There is also a lack of objective indicators that can be used to evaluate cardiac function in the progression of heart failure. Non-invasive hemodynamic parameters and routine cardiac function parameters B-type natriuretic peptide (BNP) and left ventricular ejection fraction (LVEF) in patients with chronic heart failure (CHF) were evaluated. The clinical significance of non-invasive hemodynamic parameters in the occurrence and development of chronic heart failure (CHF) was discussed. In order to provide scientific basis for early evaluation and prevention of heart failure, 119 patients with chronic heart failure and its high risk factors were selected from the heart center of Air Force General Hospital from March 2014 to October 2016. Each patient was divided into group A (pre-HF stage), group B (pre-clinical HF stage) and group C (clinical HF stage). Another 39 healthy persons were selected as normal control group (group O) at the same time. Different risk factors were divided into coronary artery disease subgroup (group A1) and hypertension subgroup (group A2). Clinical data and related examinations were collected, and noninvasive hemodynamic examinations were performed. Noninvasive hemodynamic parameters including cardiac output (SV), cardiac output (CO), cardiac index (CI), C wave amplitude, cardiac contractility index (HI), systolic function were recorded. Index (Q-B/B-X), pulmonary wedge pressure (PCWP), left ventricular end-diastolic pressure (LVEDP), aortic compliance (AC), total peripheral resistance (TPR). Serum levels of BNP and LVEF were recorded for reference. Noninvasive hemodynamic indexes, BNP and LVEF were compared and analyzed in each group. Noninvasive hemodynamic parameters, such as SV, CO, CI, C wave amplitude, HI, Q-B/B-X, PCWP, LVEDP, AC, TPR, BNP, LVEF, had significant linear correlation with different stages of heart failure. (P 0.05); C, CI, HI in the early stage of heart failure significantly decreased, Q-B/B-X significantly increased (P 0.05), non-invasive hemodynamic other indicators, BNP, LVEF values in the early stage of heart failure did not change significantly (P 0.05); Subject work characteristic curve analysis showed that HI, Q-B/B-X sensitivity, specificity were higher than other indicators, below the curve. The changes of noninvasive hemodynamic indexes were consistent with the different stages of heart failure. The changes of hemodynamics in patients with chronic heart failure in stage A, i.e. high risk factors, affected cardiac function to some extent. Noninvasive hemodynamic indexes HI, Q-B/B-X can be used to evaluate the heart in clinical practice. Objective to provide an objective reference for cardiac function in early stage of decline.
【学位授予单位】：河北北方学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.6

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