无创血流动力学监测对超重及肥胖者早期左心功能的评估作用

Non-invasive Hemodynamic Monitoring for Prophase Left Heart Function in Overweight and Obese Adults

目的应用无创血流动力学检测仪结合超声心动图评估超重及肥胖成年人的左心功能,探讨其早期心脏收缩及舒张功能的变化。方法选择2012年10月—2013年7月青岛大学医学院附属医院正常体质量、肥胖和超重的成年人223例,其中男128例,女95例;年龄(50.4±12.4)岁。按体质指数(BMI)分为正常体质量(18.5 kg/m2≤BMI<24.0 kg/m2)组(90例),超重(24.0 kg/m2≤BMI<28.0 kg/m2)组(76例),肥胖(BMI≥28.0 kg/m2)组(57例)。比较3组的超声心动图指标〔左心室射血分数(LVEF)、左房室瓣舒张早期血流速度峰值(E)/左房室瓣舒张晚期血流速度峰值(A)、左心房内径(LAD)、左室舒张末期容积(LVEDV)〕及无创血流动力学指标〔心率(HR)、心排血量(CO)、收缩压(SBP)、舒张压(DBP)、血管外周阻力(SVR)、左心做功量(LCW)、收缩时间比率(STR)〕。结果 3组间LAD和LVEDV比较,差异均有统计学意义(P<0.05);超重组及肥胖组LAD、LVEDV均大于正常体质量组(P<0.05);肥胖组LAD、LVEDV大于超重组(P<0.05)。3组间LVEF和E/A<1发生率比较,差异无统计学意义(P>0.05)。3组间CO、SBP、DBP、SVR、STR比较,差异均有统计学意义(P<0.05);超重组及肥胖组CO低于正常体质量组,而SBP、DBP、SVR、STR高于正常体质量组(P<0.05);肥胖组CO低于超重组,而SBP、DBP、SVR、STR高于超重组(P<0.05)。3组间HR、LCW比较,差异无统计学意义(P>0.05)。结论超重、肥胖可导致CO降低,LAD、LVEDV、SBP、DBP、SVR、STR增加。与超声心动图比较,无创血流动力学监测可更早期地探测到体质量增加对左心收缩及舒张功能变化的影响。

Objective To evaluate the left heart function of overweight and obese adults using non - invisive hemody- namics detector combined with echocardiogram and explore the changes of their early heart systolic and diastolic functions. Meth- ods From October 2012 to July 2013 a total of 223 adults, 128 males, 95 females, aged （50.4 ＋ 12.4） years, were divided, according toBMI, into groups A （18.5 kg/m2~〈BMI〈24.0 kg/m2, n=90）, B （24.0 kg/m2~〈BMI〈28.0 kg/m2, n= 76）, C （BMI~〉28. 0 kg/m2, n =57）. The echocardiogram indicators such as left ventricular ejection fraction （LVEF）, left atrioventricular valve peak early diastolic flow velocity （E） /left atrioventricular valve peak late diastolic flow velocity （A） , left atrial diameter （LAD）, left ventricular end- diastolic volume （LVEDV） and non- invasive hemodynamic indicators such as heart rate （HR）, cardiac output （CO）, systolic blood pressure （SBP）, diastolic blood pressure （DBP）, systemic vascular resistance （SVR）, LCW, systole time ratio （STR） were compared among the 3 groups. Results There were significant differences in LAD, LVEDV among the 3 groups （P 〈 0.05）. LAD, LVEDV were higher in groups B, C than in group A （P 〈 0.05）, higher in group C than in group B （P 〈 O. 05 ）. No difference was noted in LVEF, incidence of E/A 〈 1 among the 3 groups （P〉O. 05）, there were differences in CO, SBP, DBP, SVR, STR （P〈0.05）. CO was lower, SBP, DBP, SVR, STR higher in groups B, C than in group A （P 〈0.05）, and CO lower, SBP, DBP, SVR, STR higher in group C than ingroup B （P 〈 0. 05）. There were no differences in HR, LCW among the 3 groups （P 〉 0. 05）. Conclusion Overweight, o- besity can lead to CO reduction, increases of LAD, LVEDV, SBP, DBP, SVR, STR. As compared with echocardiogram, non - invasive hemodynamic monitoring can explore better the effects of weight increase on changes of left heart systolic and dias- tolic functions.