冠心病患者等长收缩运动时肺毛细血管嵌顿压升高的机理

The mechanism of pulmonary wedge pressure(PWP)elevation during isometric exercise(IE) in patients with coronary artery disease/

用左右心导管观察10例典型劳力性心绞痛患者在极量等长收缩运动(IE)和IE加乏氏动作时的血液动力学反应及临床表现,并以冠状动脉气囊扩张成形术建立急、慢性冠状动脉供血不足以及正常冠状动脉的模型。结果表明进行极量前臂等长收缩运动和乏氏动作时肺毛细血管嵌顿压升高,其机理可能与胸腔内压的增高和主动脉压的增高有关而与心肌缺血无关。这解释了为何等长收缩运动试验的敏感性不高,也说明对心脏患者禁止IE和乏氏动作的概念应该加以修正。

This study examined the clinical and hemodynamie responses to IE in patients undergoing percutanseous transluminal coronary angioplasty(PTCA). The results showed:mean PWP increased during sustained IE, brief IE without and with the Valsalva manoeuvre and balloon inflation respectively. The increase in mean aortic pressure during brief IE, and sustained IE was greater than during balloon dilatation. The conclusions were: PWP increased during IE which were results principally from increased LV after load with a contribution from increased perieardial pressure and from inereased in-trathoraeic pressure druing the Valsalva manoeuvre, rather than myocardial ischemia.