阻抗心动描记法在不稳定型心绞痛患者血管病变严重程度和血流动力学相关性分析中的应用价值

Value of impedance cardiography in the analysis of the correlation between the severity of angiopathy and hemodynamics in patients with unstable angina pectoris

目的探讨阻抗心动描记法(impedance cardiography,ICG)在不稳定型心绞痛(unstable angina pectoris,UAP)患者血管病变严重程度和血流动力学相关性分析中的应用价值。方法选取2018年8月至2019年8月在河北北方学院附属第一医院心内科住院治疗的125例UAP患者作为研究对象。分别于经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗前及PCI治疗后24 h、48 h、1周,使用ICG监护系统动态监测UAP患者血流动力学参数,包括心排血量(cardiac output,CO)、心指数(cardiac index,CI)、每搏排血量(stroke output,SV)、心搏容量指数(stroke volume index,SVI)及左心室射血分数(left ventricular ejection fraction,LVEF)。患者均进行冠状动脉造影,根据冠状动脉病变支数将患者分为单支病变组(n=41)、双支病变组(n=45)、多支病变组(n=39);根据Gensini评分将患者冠状动脉病变程度分为轻度组(n=40,Gensini评分≤20分)、中度组(n=48,20分55分)。使用Pearson检验分析UAP患者Gensini评分与血流动力学参数的相关关系。结果 UAP患者PCI治疗后24 h、48 h CO、CI、SV、SVI及LVEF均明显低于PCI治疗前,差异有统计学意义(P<0.05);UAP患者PCI治疗后1周CO、CI、SV、SVI及LVEF与PCI治疗前比较,差异均无统计学意义(P>0.05)。不同冠状动脉病变支数UAP患者CO、CI、SV、SVI及LVEF相比,差异均有统计学意义(P<0.05);其中单支病变组患者最高,其次为双支病变组患者,多支病变组患者CO、CI、SV、SVI及LVEF最低,两两比较差异均有统计学意义(P<0.05)。不同冠状动脉狭窄程度UAP患者Gensini评分高低依次为重度组、中度组、轻度组,CO、CI、SV、SVI及LVEF高低依次为轻度组、中度组、重度组,两两比较差异均有统计学意义(P<0.05)。UAP患者Gensini评分与CO呈负相关(r=-0.393,P<0.05),与CI呈负相关(r=-0.553,P<0.05),与SV呈负相关(r=-0.613,P<0.05),与SVI呈负相关(r=-0.624,P<0.05),与LVEF呈负相关(r=-0.710,P<0.05)。结论 ICG有助于动态监测UAP患者PCI治疗前后血流动力学状态,可作为评估患者血管病变严重程度的可靠指标。

Objectives To explore the value of impedance cardiography(ICG)in the analysis of the correlation between the severity of vascular lesions and hemodynamics in patients with unstable angina pectoris(UAP).Methods Totally 125 patients with UAP who were hospitalized in the Cardiology Department of The First Affiliated Hospital of Hebei North University from August 2018 to August 2019 were selected as the study objects.Before percutaneous coronary intervention(PCI),24 hours,48 hours and 1 week after PCI,ICG monitoring system was used to monitor the hemodynamic parameters of patients with UAP,including cardiac output(CO),cardiac index(CI),stroke output(SV),stroke volume index(SVI)and left ventricular ejection fraction(LVEF).According to the number of coronary artery lesions,the patients were divided into single vessel lesion group(n=41),double vessel lesion group(n=45),multi vessel lesion group(n=39);according to the Gensini score,the patients were divided into mild group(n=40,Gensini score≤20),moderate group(n=48,20<Gensini score≤55),severe group(n=37,Gensini score>55).Pearson test was used to analyze the correlation between Gensini score and hemodynamic parameters in patients with UAP.Results At 24 and 48 hours after PCI,CO,CI,SV,SVI and LVEF were significantly lower than those before PCI(P<0.05);there was no significant difference in CO,CI,SV,SVI and LVEF between 1 weeks after PCI compared with that before PCI(P>0.05).There were significant differences in CO,CI,SV,SVI and LVEF among UAP patients with different number of coronary artery lesions(P<0.05);among them,the patients with single vessel disease were the highest,the patients with double branch disease were the second,the patients with multi branch disease were the lowest,and there were significant differences between the any two groups(P<0.05).The Gensini scores of UAP patients with different degrees of coronary artery stenosis from high to low were severe group,moderate group and mild group respectively,the levels of CO,CI,SV,SVI and LVEF from high to low were mild group,moderate group and severe group respectively,and there were significant differences between the any two groups(P<0.05).Gensini score in UAP patients negatively correlated with CO(r=-0.393,P<0.05),CI(r=-0.553,P<0.05),SV(r=-0.613,P<0.05),SVI(r=-0.624,P<0.05),LVEF(r=-0.710,P<0.05).Conclusions ICG is helpful to dynamically monitor the hemody⁃namic state of patients with UAP before and after PCI,and it can be used as a reliable index to evaluate the severity of vascular disease.