前负荷再充盈搏功在评价瓣膜病围术期左心功能中的应用

Preload Recruited Stroke Work as an Index to Study Left Ventricular Contractility During One Valve Replacement

目的评价不受左心室负荷影响而较客观地反映其心肌收缩性能的指标，前负荷再充盈搏功（ＰＲＳＷ）在瓣膜病围术期中的应用价值。方法２０例患者中风湿性心脏瓣膜病（ＲＨＤ）组为研究组（ｎ＝１４）；先天性心脏病（ＣＨＤ）组作对照（ｎ＝６）。手术前后以心外膜超声测左心室容积并测左心室压，暂阻断下腔静脉改变左心室前负荷以绘出不同前负荷的左心室压－容积环推导出ＰＲＳＷ。结果ＰＲＳＷ：ＲＨＤ组术前７．９２７±０．５９Ｐａ，术后４．９７±０．６４Ｐａ（Ｐ＜０．０５）；术前ＲＨＤ组与ＣＨＤ对照组无差别，术后明显小于ＣＨＤ组。结论ＰＲＳＷ可用于评价术后瓣膜病左心功能。

Objective The load independent index for evaluating cardiac contractile functionpreload recruited stroke work (PRSW) was used to assess the valvular heart function. Methods Fourteen patients with rheumatic heart disease(RHD) were investigated and six patients with congenital heart disease(CHD) as the control were investigated. The signals of left ventricular volume by epicardial echocardiography and left ventricular pressure were interfaced so as to delineate the left ventricular pressure volume loops. After a transient occlusion of the inferior vena cava to alter preload, a pressure volume loops were generated prior to onset of barocepter reflex mediated increase in heart rate, PRSW was thus obtained. It was done before and after operation. Results The preoperative and postoperative PRSW of RHD group were 7 92±0 59Pa and 4 97±0 64Pa respectively ( P <0.05).There was not significant difference between CHD group before and after procedure. Conclusion PRSW can be used to assess heart function of RHD after operation, and the left ventricular contractility decreases.