卧位型心绞痛容量负荷试验

Responses to the volume load on patients with noctural angina

目的 :探讨卧位型心绞痛发生机制 ,为临床治疗提供理论依据。方法 :选择卧位型心绞痛 2 0例 ,混合型心绞痛 12例 ,劳力型心绞痛 10例 ,采用 Swan- Ganz导管检查及容量负荷试验 ,结合无创检查中心脏 X线片、超声心动图、心脏放射性核素检查指标 ,判断心功能状态 ,并给予相应治疗。结果 :1卧位型心绞痛者容量负荷前后平均肺动脉压、肺楔嵌压 ( PWP)均较其他类型心绞痛者高 ( P <0 .0 1) ,负荷后卧位型心绞痛者平均肺动脉压、PWP升高 ,心脏指数下降 ,与其他组比较有显著性差异 ( P <0 .0 5 )。 2 6例容量负荷前 PWP正常的卧位型心绞痛者 ,负荷后 PWP明显升高≥ 18m m Hg。 3与有创检查中 PWP相比 ,无创检查中心脏表面积、左室舒张末径明显增大 ,射血分数值显著下降 ,是判定收缩功能障碍的良好指标 ,而心脏表面指数、左室舒张末径、射血分数值正常而 E/ A<1,高峰充盈率降低且肺淤血征阳性亦存在舒张功能障碍。结论 :卧位型心绞痛的发生与心功能不全密切相关 。

Objective:Through response to the volume load, to explore the mechanism of noctural angina and provide theoretical basis for clinical treatment.Method:In 20 cases with noctural angina,12 cases with mixed angina and 10 cases with exertional angina,we used hemodynamic monitor to decide heart function during volume load by the Swan Ganz catheter.We also used undamaged examination as X rays of heart,echocardiogram (UCG),emission computerized tomography (ECT) and gave relative treatment to observe the situation of the symptom.Result:Study discovered mean pulmonary artery pressure (MPAP) and pulmonary wedge pressure (PWP) in patients with noctural angina were higher than patients with other kind of angina (P< 0.01 ).After volume load,MPAP and PWP increased and cardial index decreased in patients with noctural angina,which had significant difference (P< 0.05 ).In 6 cases with noctural angina,PWP was normal before volume load.But after volume lead,the PWP was increased≥18 mmHg.Compared with PWP in the damaged examination,cardial area index (CAI),left ventricular diastolic diameter (LVDD) enlargement and ejective fraction(EF) decreasing were good index for evaluating systotic function in undamaged examination.Normal CAI,LVDD,EF,E/A<1, low peak fulling rate (PFR) and pulmoary congestion indicated diastolic disfunction.Conclusion:Noctural angina is associated with heart failure.Diastolic disfunction is common.