小循环心功能无创检测法评价肺心病左心功能的临床观察

EVALUATION OF LEFT HEART FUNCTION BY RIGHT CHEST ELECTRIC ADMITTANCE PLETHYSMOGRAPHY IN PATIENTS WITH COR PULMONALE

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摘要本文对２８例肺心病患者进行小循环心功能检查，同时做多普勒超声心动图，核素心血池扫描等检查，并做对比分析。结果表明，肺心病患者左室最大充盈（ＬＰＦＲ）明显低于正常。二尖瓣瓣口舒张期血流频谱示Ｅ峰减低，Ａ峰增高，Ｅ／Ａ＜１。以上二项检查表明，肺心病患者存在左室舒张功能异常。小循环心功能示，肺心病患者ｈＣ／ｈＺ＞６５％异常者占７８％，Ｑｊ／ｊｚ＞５０％异常者占８９％，提示左心前负荷增加，小循环心功能与核素心血池扫描，多普乐超声心动图检测结果基本相符，说明该技术测定心功能是可行的。肺心病造成左室舒张功能异常可能与缺氧、酸中毒引起的心肌病理改变有关，因而影响左心室顺应性。肺心病患者右心室增大，室间隔向左凸起，改变左心室构形，影响左心室充盈，也加重了左心室舒张功能障碍。 We investigated the changes of left heart function in 28 patients with cor pulmonale by three non invasive methods, namely, radionuclide ventriculography, Doppler echocardiography and right chest electric admittance plethysmography and the results were compared. The radionuclide ventriculography revealed a significantly lower left ventricular peak filling rate (LVPFR); the Doppler echocardiography showed lower peak E wave, higher peak A wave and a E/A ratio<1 on the diastolic trans mitral valve blood flow spectrum as compared with their respective normal values. These data suggested the existance of diastolic dysfunction of the left ventricle in patients with cor pulmonale. In the same group of patients, right chest electric admittance plethysmography disclosed Hc/Hz≥65% in 22 patients (78.6%) and Q j/j z≥50% in 14(50%). These indicated increase of the preload of left ventricle which was basically in accordance with the findings of the other two methods. This indicated that right chest electric admittance plethysmography was a useful technique in evaluation of the left heart function. In patients with cor pulmonale, the diastolic function of the left ventricle was probably jeopardized by several factors, including chronic anoxemia and acidosis, and the geometric disfiguration of left ventricle due to compression from the enlarged right ventricle insid of the pericardial sac and by the protruding of the hypertrophic interventricular septum toward left side during diastole. The last event was attributed to increased pressure gradient between two ventricles during diastole because of higher diastolic pressure in the right ventrcle and inadequate filling of the left ventricle.