增强型体外反搏对冠心病患者外周循环即时血流动力学影响的临床观察研究

Clinical observation of the effect of enhanced external counterpulsation on the immediate hemodynamics of patients with coronary heart disease

目的观察冠状动脉粥样硬化性心脏病(冠心病)患者在增强型体外反搏(EECP)的作用下,其对外周循环(颈总动脉、肱动脉)血流动力学的即时影响。方法连续入选2018年8月至2018年12月于中山大学附属第八医院(深圳福田)心内科门诊及住院的冠心病患者(n=97),所有患者均进行1次45 min体外反搏治疗,在体外反搏治疗前、中、后使用超声多普勒评价颈总动脉和肱动脉血流动力学参数的变化特性,包括收缩期峰值流速(PSV)、舒张期峰值流速(PDV)、舒张末期流速(EDV)、时间-平均峰值流速(TAMAX)、搏动指数(PI)、阻力指数(RI)和血流量(FR)。结果颈总动脉血流量在反搏过程中升高(P<0.01),反搏后仍有上升趋势,而肱动脉血流量在反搏前、反搏中及反搏后差异无显著性(P>0.05)。在反搏过程中,PI、RI及PDV均升高(P<0.05),而EDV显著降低(P<0.01),反搏后均恢复至反搏前水平。PSV、TAMAX在反搏前、反搏中及反搏后差异无显著性(P>0.05)。结论EECP能有效增加颈总动脉及肱动脉舒张期血流速度,并增加颈动脉平均血流量,提示EECP干预对冠心病患者外周循环的血流动力学有积极的影响。

Objective To observe the immediate effect of coronary artery disease patients on the hemodynamics of peripheral circulation(common carotid artery,brachial artery)under the action of enhanced external counterpulsation(EECP).Methods From August 2018 to December 2018,patients with coronary heart disease(n=97)were included in the outpatient and cardiology department of the Department of Cardiology,the Eighth Hospital of Sun Yat-sen University(Futian,Shenzhen).All patients underwent one 45-minute external counterpulsation treatment.Before,during,and after external counterpulsation therapy,ultrasound Doppler was used to evaluate the changes in hemodynamic parameters of the common carotid and brachial arteries,including peak systolic velocity(PSV),peak diastolic velocity(PDV),and end-diastolic Flow rate(EDV),time-average peak flow rate(TAMAX),pulsatility index(PI),resistance index(RI)and blood flow(FR).Results The FR of carotid artery was significantly increased during EECP(P<0.01),and after EECP it still had an increasing trend,while there was no difference in the FR of brachial artery before,during and after EECP(P>0.05).During EECP,PI,RI and PDV were significantly increased(P<0.05),while EDV was significantly decreased(P<0.01),and all returned to the precounterpulp level after counterpulsation.There was no difference in the PSV and TAMAX before,during and after EECP(P>0.05).Conclusion EECP can effectively increase the diastolic blood flow velocity of common carotid artery and brachial artery,and increase the average blood flow of carotid artery.It suggested that EECP intervention has a positive effect on peripheral hemodynamics of CHD patients.