三种类型的不稳定型心绞痛心脏功能状态比较

The study of heart functional state in three types of unstable angina pectoris

目的 :通过有创的血流动力学检查 (Swan Ganz导管 )加容量负荷试验以及无创的心功能检查〔超声心动图 (UCG)及门控心血池显像〕来评价不同类型的不稳定型心绞痛 (UAP)心功能状态以及心脏储备功能。方法 :选择 70例UAP患者 (包括卧位型 2 5例 ,混合型 2 3例 ,恶化劳累型 2 2例 )。每例皆摄心脏三位片 ,作心电图(ECG)、UCG、门控心血池显像及冠状动脉造影及血流动力学检查及容量负荷试验。观察不同类型的UAP与心功能状态的关系 ;将血流动力学结果和容量负荷试验结果进行对比。结果 :①卧位型组有舒张功能障碍者 12例(4 8.0 % ) ,收缩功能障碍者 9例 (36 .0 % ) ,负荷试验阳性者 11例 (4 4.0 % ) ;混合型组分别为 3例 (13.0 % ) ,10例(4 3.5 % ) ,11例 (4 7.8% ) ;恶化劳累型组分别为 7例 (31.8% ) ,2例 (9.1% ) ,4例 (18.2 % )。② 3种类型UAP的基础心功能相比较 ,恶化劳累型组者的心胸比例、心脏表面积指数 (CAI)、平均肺动脉压 (mPAP)、肺动脉楔嵌压(PCWP)明显低于卧位型组 ,心脏指数 (CI)高于卧位型组 (P <0 .0 5 ) ;混合型组仅mPAP、PCWP低于卧位型组(前者 P <0 .0 5 ,后者 P <0 .0 1) ,余者差异无显著性意义。结论 :卧位型心绞痛以舒张功能障碍、收缩功能障碍者为多 ,混合型以心功能正常。

Objective: To assess the state of heart function and cardiac reserve function in different types of unstable angina pectoris (UAP) by hemodynamic test (Swan Ganz catheterization), volume loading test, non invasive methods (UCG, gated cardiac blood pool imaging) and coronary artery angiography. Method:Seventy patients with UAP (including angina decubitus in 25 cases, mixed angina in 23 cases, accelerated angina in 22 cases) were studied according to WHO criteria in 1979. The patients were divided into three groups based on test results: the group of diastolic dysfunction, systolic dysfunction and normal heart function.Result:① There were diastolic ( 48.0 %), systolic ( 36.0 %) dysfunction and normal heart function (16%) in angina decubitus; 13%, 43.5 % and 43.5 % in mixed angina respectively; 31.8 %, 9.1 % and 59.1 % in accelerated angina respectively. ② Cardiothoracic ratio, CAI, mPAP and PCWP were reduced in accelerated angina, but CI was higher (P< 0.05 ) in contrasting with those in angina decubitus. Mixed angina had significantly reduced mPAP and PCWP (P< 0.05 ), but no significant changes in cardiothoracic ratio, CAI and CI in contrasting with angina decubitus. ③ There were two types of reaction to volume loading test: negative reaction and positive reaction. Cardiothoracic ratio and PCWP in positive patients were greater than those in negative ones (P< 0.01 ), but EF UCG ? EF ECT and CI were lower (P< 0.05 ). Whereas basic heart function in positive patients were located at lower limit of normality, their mPAP and PCWP were much higher (P< 0.01 ) and CI lower (P< 0.05 ).Conclusion:① There is chiefly diastolic and systolicdysfunction in angina decubitus, and normal heart function and systolic dysfunction in mixed angina, and normal basic heart function and diastolic dysfunction in accelerated angina; ② The basic heart function in accelerated angina is the best, the next is mixed angina, and that in angina decubitus is bad. ③ The basic heart function and reserve function in negative patients are better than that in positive patients. ④ By volume loading test, those patients with pre clinic heart dysfunction can be found.