无创方法评价高血压患者心力储备功能的临床研究

Clinical study on evaluating the function of cardiac reserve in hypertensive patients with noninvasive techniques

目的:采用心音图运动试验和彩色多谱勒超声心动图,检测心脏受损程度不同的高血压患者的心力储备情况以评估其临床价值,并探讨这两种无创方法之间的相关性。方法:分别对正常对照20例、按心脏损害程度不同的3组高血压患者(A、B、C)各20例,进行心音图运动试验,测量各受试者的心肌收缩力储备指数(Cardiac contractility reserve index,CCRI);利用心脏彩色超声心动图、心电图、同步监测血压技术测定各受试者收缩末期、舒张末期容积,左室收缩、舒张末期室壁厚度和血压值,求得最大弹性模量(Emax)、最大心肌劲度(maxEav)、射血分数(EF),然后对两种检查所获得的指标进行相关性分析。结果:(1)Emax、maxEav、EF3个指标除高血压A组外,对照组与B、C组间及A、B、C各两组间均有显著性差异(P<0.05);(2)CCRI:对照组与高血压各组以及高血压病各组间均有显著性差异(P<0.01);(3)CCRI与Emax、maxEav、EF呈明显正相关(P<0.01)。结论:(1)CCRI与Emax、maxEav、EF均能反映高血压患者心力储备的下降。(2)心音图运动试验揭示高血压患者早期心力储备的下降可能比彩色多谱勒超声心动图更灵敏。

Objective：To explore whether phonocardiogram exercise test （PCGET） or doppler echocardiography can sensitively and specifically detect the changes of cardiac reserve in patients with hypertension and whether there is a relationship between the two methods. Methods：The trail was performed with eighty volunteers, including twenty healthy persons as control group, and sixty hypertensive patients, which were divided into three subgroups： hypertension A, HA（patients without left ventricular hypertrophy, LVH and enlarged left ventricle）; hypertension B, HB （patients with only LVH ） and hypertension C, HC （patients with both LVH and enlarged left ventricle ）.The cardiac contractility reserve index （CCRI） was measured by PCGET, while the value of LV end-systolic and end-diastolic long and short axis dimensions, wall thickness and synchronous blood pressure were measured by the technique of simultaneous screen display of electro- cardiography and synchronously monitoring blood pressure. According to the parameters measured by the latter technique, the values of maximum elasticity （Emax）, the average maximum myocardial elasticity stiffness （maxEav） and ejection fraction （EF）were calculated by computer programmed process. Results： （1）Compared with control group, there was a statistically significant difference between the hypertension groups except HA group,and also an obvious difference between HB and HC about the indexes of Emax, maxEav and EF（P〈0.05）. There was a significant difference both between the all hypertension groups in comparison with control group and between three hypertension groups About CCRI （P〈0.01）. （3）There was a positive correlation between CCRI and Emax, maxEav and EF （P〈0.01）. Conclusions： （1）CCRI, Emax, maxEav and EF can all reflect the decrease of cardiac reserve in hypertensive patients. （2）PCGET may be more sensitively than Doppler echocardiography in reveal the impairment of cardiac reserve in the early hypertension.