增强型体外反搏治疗对老年射血分数保留心力衰竭患者的疗效

The effect of enhanced external counterpulsation on heart failure with preserved ejection fraction in the elderly

目的探讨增强型体外反搏(EECP)治疗老年左心室射血分数保留的心力衰竭(HFpEF)患者的作用和血流动力学效应。方法回顾性分析2018年1月至2019年12月在山东大学齐鲁医院体外反搏中心登记治疗的66例老年HFpEF患者的临床资料。主要观察指标为6 min步行距离试验,次要指标为明尼苏达心力衰竭生活质量调查表(MLHFQ)评分,监测无创血流动力学指标心指数、每搏量、等容舒张期、肺毛细血管嵌压、总外周阻力,并计算平均动脉压。结果 EECP治疗后与治疗前比较,6 min步行距离改善[(372±87)m比(341±85)m,P<0.05];MLHFQ量表评分降低[(47±16)分比(50±17)分,P<0.05];无创血流动力学测定心脏泵血功能参数,心指数增加(2.8±0.7)L·min-1·m-2比(2.6±0.6)L·min-1·m-2(P<0.05),每搏量(73.3±16.4)ml比(71.5±17.1)ml(P>0.05);前负荷参数肺毛细血管嵌压(10.0±3.3)mmHg比(11.0±3.6)mmHg(1 mmHg=0.133 kPa,P>0.05);心脏舒张功能参数等容舒张期(98.0±29.5)ms比(91.0±29.1)ms(P>0.05);心脏后负荷指标总外周阻力降低,(1 719.0±427.0)DS/cm5比(1 821.0±508.0)DS/cm5(P<0.05);平均动脉压(96.9±10.7)mmHg比(98.8±13.1)mmHg有改善,但差异无统计学意义(P>0.05)。但按初始平均动脉压分层分析,高血压患者(14例)较非高血压患者降低(P<0.05)。结论老年HFpEF患者应用EECP治疗能提高6 min步行距离,改善生活质量和血流动力学参数,是老年HFpEF患者一项安全的辅助治疗措施。

Objective To investigate the effect of enhanced external counterpulsation(EECP)on heart failure with preserved ejection fraction(HFpEF)and hemodynamics in elderly patients.Methods Clinical data of 66 elderly HFpEF patients admitted to the enhanced external counterpulsation center of our hospital from January 2018 to December 2019 were retrospectively analyzed.The primary assessment parameter was the six-minute walk distance,and the secondary parameters included the Minnesota Living with Heart Failure Questionnaire(MLHFQ).Noninvasive hemodynamic parameters including the cardiac index(CI),stroke volume(SV),isovolumic relaxation period(A2-mitral valve opening,A2-O),pulmonary capillary wedge pressure(PCWP)and total peripheral resistance(TPR)were monitored and mean arterial blood pressure(MAP)was calculated.Results After EECP treatment,the six-minute walk distance increased(372±87 m vs.341±85 m,P<0.05),the score of MLHFQ decreased(47.0±16.0 vs.50.0±17.0,P<0.05),CI increased(2.8±0.7)L·min^(-1)·m^(-2)vs.(2.6±0.6)L·min^(-1)·m^(-2)(P<0.05),SV,PCWP and A2-O did not show significant change(73.3±16.4 ml vs.71.5±17.1 ml,10.0±3.3 mmHg vs.11.0±3.6 mmHg,1 mmHg=0.133 kPa,98.0±29.5 ms vs.91.0±29.1 ms,P>0.05),TPR decreased(1719.0±427.0 DS/cm^(5)vs.1821.0±508.0 DS/cm^(5),P<0.05),and there was no significant change in MAP(96.9±10.7 mmHg vs.98.8±13.1 mmHg,P>0.05),compared with pre-EECP treatment levels.Compared with patients without hypertension,MAP decreased in patients with hypertension(14 cases),when stratified by the initial MAP(P<0.05).Conclusions For elderly patients with HFpEF,EECP can increase the six-minute walk distance,improve the quality of life and hemodynamic parameters,and is a safe adjuvant treatment.