脉冲多普勒超声心动图对室性早搏时血液动力学定量研究

Hemodynamic Study on Ventricular Premature Depolarization by Pulsed Doppler Echocardiography

目的：探讨室性早搏对心脏排血和充盈的血液动力学变化的影响。方法：对４０例室性早搏（室性早搏组）的患者及３０例程控刺激（程控刺激组）诱发室性早搏的患者记录二尖瓣口及主动脉瓣口的血流频谱，分别测量室性早搏前正常心动周期二尖瓣口和主动脉瓣口的流速积分（ＮＭＶＩ和ＮＡＶＩ），室性早搏时二尖瓣口和主动脉瓣口的流速积分（ＥＭＶＩ和ＥＡＶＩ），及代偿心搏（室性早搏后）二尖瓣口和主动脉瓣口的流速积分（ＰＭＶＩ和ＰＡＶＩ）。结果：ＥＭＶＩ和ＥＡＶＩ明显低于ＮＭＶＩ和ＮＡＶＩ，ＰＭＶＩ和ＰＡＶＩ显著高于ＮＭＶＩ和ＮＡＶＩ，但仅代偿３６％和３８％。室性早搏提前指数Ｔ－Ｒ′／Ｒ－Ｒ与室性早搏排血比值（ＥＡＶＩ／ＮＡＶＩ）及室性早搏充盈比值（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。结论：室性早搏时心搏量和充盈量明显下降，室性早搏后的心搏量和充盈量增高，但代偿不足。当Ｔ－Ｒ′／Ｒ－Ｒ＜０．２２时，ＥＡＶＩ／ＮＡＶＩ降至０。

Objective:To study the hemodynamics of ventricular premature depolarization(VPD)by pulsed Doppler echocardiography. Methods:Pulsed Doppler was used to assess transmitral flow and transaortic flow at apical 4 and 5 chamber views in 40 patients with VPD and 30 with VPD induced by programed stimulation.Integrals of transmitral and transaortic flow velocity(MVI,AVI) were measured in sinus beat before(NMVI,NAVI) and after VPD (PMVI,PAVI) as well as during VPD(EMVI,EAVI). Results:EAVI and EMVI were 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 prematurity index( T R′ /R R)correlated well with EMVI/NMVI and EAVI/NAVI.When T R′/R R<0.22,EAVI/NAVI decreased to 0,that is no blood flow output. Conclusions:The AVI and MVI decrease significantly during VPD while the PAVI and PMVI increase,but the compensation is not complete.When T R′/R R<0.22,EAVI/NAVI decrease to 0,attention should be paid to VPD.