慢性肺心病左心功能的评价

AN EVALUATION OF THE LEFT VENTRICULAR FUNCTION OF CHRONIC COR PULMONALE

慢性肺心病(肺心病)左心是否受到损害,一直是一个争论的问题.本文以超声心动图对肺心病及冠心病者的心脏解剖与功能作一初步探讨.发现反映左心收缩功能的mVcf正常,而SV、LVEF减低及PEP/LVET增加却反映左心泵血功能减低,但不如冠心病者明显.此乃由于肺心病人因肺动脉阻力增大,压力增高及右心功能减低,右心掏出量减低而影响左心前负荷,以致在心室充盈压减低,并非左室收缩功能不全.此外,反映左心舒张功能的指标加快充盈期充盈量及充盈比数等减低,二尖瓣前叶斜率减慢,乃由于胸腔内压增大,以及右室增大而限制了左室扩张,妨碍了左室的充盈(也并非为左室舒张功能不全所致);而冠心病人的左室收缩与舒张功能均有明显的减低.左室容量,体积及重量,肺心病人均在正常范围内,冠心病人却均较高.

It is still a controversal problem whether the left ventricular function is impaired in chronic cor pulmonale. This paper aims at making ana-tomical and functional studies of the heart through comparison of the patients with chronic cor pulmonale and coronary heart disease by echo-cardiogragh. It was found that, in patients with cor pulmonale, the mVcf was normal. suggesting that the systolic function of the left ventricle was normal. However, a decrease in the SV, LVEF and an increase in PEP/ LVEF, reflect the slightly-impaired function of left ventricular pumping power. But it is less evident as that in patients with coronary heart disease. It is supposed to be due to the increased resistance and pressure of the pulmonary artery, impairing the right heart function and decreasing the stroke volume of the right ventricle. Thus the pre-load and filling pressure of the left ventricle are decreased, which does not necessarily mean insufficiency of the left ventricular systolic function.The indicators reflecting the left ventricular diastolic function as rapid filling volume and fraction were decreased, and the slope of the anterior mitral valve leaflet was slowed. These may result from increased intrathoracic pressure and limited left ventricular dilatation by enlarged light ventricle, thus preventing the left ventricular from filling. It can not draw the conclusion that it is due to insufficiency of the left ventricular diastolic function. But the systolic and diastolic functions of the left ventricle in patients with coronary heart disease are evidently impaired.The volume, capacity and mass of the left ventricle in patients with. chronic cor pulmonale were all in" normal range, but they were all larger in patients with coronary heart disease.