本文選題：心功能不全 + 二尖瓣反流速度�。� 參考：《山東大學(xué)》2015年碩士論文

【摘要】：研究背景：心力衰竭(簡稱心衰)是各種心臟病進(jìn)展的嚴(yán)重階段。目前為止臨床醫(yī)生評(píng)價(jià)病人心功能仍然依靠臨床癥狀、體征、化驗(yàn)指標(biāo)及超聲資料等有機(jī)結(jié)合判斷。射血分?jǐn)?shù)(LVEF)是評(píng)價(jià)左室收縮功能的重要指標(biāo)。臨床工作中常常發(fā)現(xiàn),有些心力衰竭患者射血分?jǐn)?shù)己明顯下降,甚至達(dá)30%以下,卻無明顯氣短或呼吸困難等癥狀,尚能進(jìn)行適當(dāng)活動(dòng)；同時(shí)也觀察到部分心衰患者,雖然射血分?jǐn)?shù)正常,但胸悶氣短、呼吸困難己非常明顯。除了左室收縮功能以外,病人的心功能狀態(tài)還與左室舒張功能及肺動(dòng)脈壓有關(guān)。目的：本實(shí)驗(yàn)旨在觀察缺血性心臟病患者心功能狀態(tài)與肺動(dòng)脈壓力的相關(guān)性,重點(diǎn)探討肺動(dòng)脈壓力與二尖瓣反流速度、心臟各腔徑大小、左室射血分?jǐn)?shù)及血漿N端腦鈉肽前體之間的關(guān)系,進(jìn)而為指導(dǎo)臨床醫(yī)生早期預(yù)測肺動(dòng)脈壓,采取措施,防止肺動(dòng)脈升高,改善患者生活質(zhì)量。方法：連續(xù)入選2013年12月至2014年8月因缺血性心臟病合并心力衰竭入住東阿縣人民醫(yī)院心內(nèi)科的住院患者118例,入院當(dāng)天行超聲心動(dòng)檢查,于胸骨旁左室長軸切面舒張末期垂直于二尖瓣踺索中段平面測量左室前后徑(單位：毫米),右心室前后徑,同時(shí)于胸骨旁左室長軸切面收縮末期測量左房前后徑(單位：毫米)、于心尖四腔切面應(yīng)用simpson s法測量EF值,同時(shí)測量二尖瓣反流速度(單位：厘米\秒)、三尖瓣反流速度,依據(jù)三尖瓣反流壓力階差估測肺動(dòng)脈收縮壓(單位：毫米汞柱)。按照美國紐約心臟病學(xué)會(huì)(New York Heart Association NYHA)心功能分級(jí)標(biāo)準(zhǔn)及左心室射血分?jǐn)?shù)將病人分為三組：A組EF正常+NYHAⅠ～Ⅱ級(jí),共36人；B組EF降低+NYHA Ⅰ～Ⅱ級(jí),共34人；C組EF降低+NYHA Ⅲ～Ⅳ級(jí),共48人。血液標(biāo)本化驗(yàn)N端腦鈉肽前體(NT-proBNP單位：pg/ml)。采用統(tǒng)計(jì)方法,統(tǒng)計(jì)方法采用卡方檢驗(yàn)及配對(duì)t檢驗(yàn)、相關(guān)分析,運(yùn)用SPSS17.0統(tǒng)計(jì)軟件對(duì)實(shí)驗(yàn)結(jié)果進(jìn)行統(tǒng)計(jì)分析。結(jié)果：在缺血性心臟病發(fā)生心力衰竭的患者中,C組射血分?jǐn)?shù)降低、心功能Ⅲ～Ⅳ級(jí)的一組患者,肺動(dòng)脈壓力力明顯升高；A組EF正常心功能Ⅰ-Ⅱ級(jí)和B組EF降低心功能Ⅰ-Ⅱ級(jí)2組患者肺動(dòng)脈無明顯升高。進(jìn)一步對(duì)肺動(dòng)脈高壓一組(C組)進(jìn)行肺動(dòng)脈壓相關(guān)因素分析,發(fā)現(xiàn)患者肺動(dòng)脈壓力與左房前后徑呈正相關(guān),與左室前后徑呈正相關(guān),與右心室前后徑呈正相關(guān),與二尖瓣反流速度呈正相關(guān)；N端腦鈉肽呈正相關(guān),與射血分?jǐn)?shù)呈負(fù)相關(guān)。三組間藥物應(yīng)用差異無統(tǒng)計(jì)學(xué)意義。結(jié)論：在缺血性心臟病發(fā)生心力衰竭患者中,患者臨床心功能狀態(tài)的下降與肺動(dòng)脈壓力升高具有相關(guān)性；患者肺動(dòng)脈壓力與左房內(nèi)徑、左心室舒張末內(nèi)徑、右心室舒張末內(nèi)徑、N端腦鈉肽及二尖瓣反流速度均呈正相關(guān),與左室射血分?jǐn)?shù)呈負(fù)相關(guān),以上指標(biāo)可作為患者肺動(dòng)脈壓力升高的預(yù)判指標(biāo),臨床醫(yī)生可在肺動(dòng)脈壓升高前盡早采取再灌注或血管重建措施,防止肺動(dòng)脈升高,改善患者生活質(zhì)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.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R541.6

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本文編號(hào)：1740223