脉冲多普勒超声对室性早搏血流动力学变化的定量研究

STUDY ON HEMODYNAMICS OF VENTRICULAR PREMATURE DEPOLARIZATION BY PULSED DOPPLER ECHOCARDIOGRAPHY

应用脉冲多普勒超声技术对４０例室性早搏（室早）患者的主动脉瓣口和二尖瓣瓣口流速积分（ＡＶＩ，ＭＶＩ）进行测量。结果显示ＡＶＩ和ＭＶＩ室早时明显低于同体窦性心律时（ＮＡＶＩ和ＮＭＶＩ），Ｐ均＜０．００１。代偿ＡＶＩ和ＭＶＩ（ＰＡＶＩ和ＰＭＶＩ）均高于ＮＡＶＩ和ＮＭＶＩ，Ｐ均＜０．００１，但仅能代偿３６％和３８％。室早提前指数（Ｔ－Ｒ＇／Ｒ－Ｒ）与室早排血比值（ＥＡＶＩ／ＮＡＶＩ）及室早充盈比值（ＥＭＶＩ／ＮＭＶＩ）呈良好相关，当Ｔ－Ｒ＇／Ｒ－Ｒ＜０．２２时，ＥＡＶＩ／ＮＡＶＩ降至０，即无血液排出。本研究表明：脉冲多普勒超声可作为研究和评估室早血流动力学变化的非创性诊断技术；室早时心搏量和充盈量明显下降，室早后心搏量和充盈量代偿不足；室早发生的时间与左室充盈和心搏量的降低密切相关；过早发生的室早在临床上应予以足够重视。

Limited data are available on hemodynamic during ventricular premature depolarization(VPD)and post VPD beat.The authors used pulsed Doppler to assess transmitral flow from mitral tip and transaortic flow from aortic tip at apical 4 and 5 chamber views in 40 subjects with VPD,all without organic heart diseases. Transmitral and transaortic flow velocity integral (MVI,AVI) were measured in sinus beat (SB) before (NMVI,NAVI) and after VPD (PMVI,PAVI) as well as duing VPD (EMVI,EAVI). LV filling ratio (LVFR) of VPD beats were calculated by EMVI/NMVI,and LV output ratio (LVOR) were calculated by EAVI/NAVI. EAVI and EMVI were all significantly lower than NAVI and NMVI respectively. PAVI and PMVI were all significantly higher than NAVI and NMVI,but only compensated 36%and 38%, respectively. The prematuity index correlated well with lVOR and LVFR.When T-R'/R-R<0.22,EAVI/NAVI decreased to 0,that is, no blood flow output. It was concluded that: (1) The AVI and MVI decreas significantly during VPD. The PAVI and PMVI increase, but the compensation are not complete. (2) When T-R'/R-R<0.22,EAVI/NAVI decrease to 0, EMVI/NMVI<0.23, The VPD should be paid attention to.