乏氏动作对冠心病患者等长收缩运动时中心血流动力学的影响

Effects of Valsalva manoeuvre on central haemodynamic response to isometric exercise in patients with coronary artery disease

观察１０名冠心病人在冠状动脉腔内成型术前后，进行等长收缩运动和乏氏动作对中心血流动力学的影响。１０名对象均为男性，平均年龄５２岁，单支血管病变伴劳力性心绞痛，左心功能基本正常。采用冠状动脉腔内成型术导管测定主动脉压力，右心导管测定右心房和肺毛细血管嵌顿压以及肺动脉压力。运动为极量握力运动。运动中无１例病人发生临床可判断的心肌缺血，所有病人均无症状，附加乏氏动作对中心血流动力学的反应类型无明显影响。肺毛压在附加乏氏动作时增加较明显，但右房压也同时成比例增高。右房压与肺毛压变化的相关系数为０．９４８。基本反应特征在成功的冠状动脉腔内成型术后无明显改变。结果提示乏氏动作并不急剧增加等长收缩运动时的心血管反应，其肺毛压增高的机理与胸腔压力增高有关而与心肌缺血无关。

It's studied that 10 male patients (meanage 52 years) with effort angina and preserved left venticular funct ion during right ang left heart catheterisation using maximal voluntary handgrip contraction with and without the Valsalva manoeuvre (VALS). None of the subjects developed angina and/or ST segment depression during the tests. Both mode of exercise produced similar haemodynamic responses;significant increase in aortic systolic pressure associated with parallel increase in diastolic pressure and trans-coronary vascular pressure gradient.Pulmonary wedge pressure (PWP) increased more markedly during the exercise with VALS(P<0.05). However, right atrial pressure (RAP)also presented parallel increase, indicating significant increase of intrathoracic pressure. The correlation coefficient between in crease of PWP and RAP is 0. 948. The results suggested that VALS did not exaggerate hemodynamic response to isometric exercise but did add effects on the rise of PWP, which, however,is not due to myocardial ischemia but due to increase of intrathoracic pressure. Author's address: Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University