心脏彩超诊断慢性心力衰竭的应用价值分析

Application value analysis of cardiac color Doppler ultrasound in diagnosing chronic heart failure

目的探讨应用心脏彩超诊断多病因慢性心力衰竭的价值,为临床诊断提供参考。方法回顾性选取2018年1月至2020年11月运城市中心医院收治的120例多病因慢性心力衰竭患者作为研究对象(研究组),根据左室射血分数(LVEF)值分为两组,LVEF正常者31例(A组),LVEF下降者89例(B组);根据心功能美国纽约心脏病协会(NYHA)分级:Ⅰ级21例,Ⅱ级49例,Ⅲ级31例,Ⅳ级19例。另选同期年龄段相近健康体检者80名作为对照组。检测并统计分析3组受试者LVEF、左心室舒张末期内径(LVDD)和左心房内径(LAD)的差异性及其与心功能分级的关系。结果研究组LVEF为(46.86±8.91)%,显著低于对照组[(69.85±7.47)%],LVDD和LAD分别为(56.57±7.44)、(47.67±7.31)mm,显著高于对照组[(49.93±5.13)、(22.95±6.05)mm],差异均有统计学意义(P<0.05)。A组LVEF为(62.61±12.27)%,显著高于B组[(35.94±11.63)%],LVDD和LAD分别为(55.37±7.31)、(44.73±7.51)mm,显著低于B组[(58.97±7.17)、(48.65±6.79)mm],差异均有统计学意义(P<0.05)。心功能Ⅲ级和Ⅳ级的患者LVEF显著低于Ⅰ级和Ⅱ级的患者,LVDD和LAD明显低于Ⅰ级和Ⅱ级的患者,差异均有统计学意义(P<0.05),但心功能Ⅰ级与Ⅱ级、Ⅲ级与Ⅳ级的患者LVEF、LVDD及LAD相比差异无统计学意义(P>0.05)。结论心脏彩超可动态显示患者心脏结构、血液流速及波动速度状态,可作为多病因慢性心力衰竭诊断、治疗评估及治疗方案调整的辅助手段,但不能作为鉴别诊断的单一依据,须结合临床症状、体征、病因、病史等进行系统鉴别。

Objective To discuss the value of using cardiac color Doppler ultrasound in the diagnosis of chronic heart failure with multiple causes,and provide references for clinical diagnosis.Methods A total of 120 patients with multi-cause chronic heart failure admitted to Yuncheng Central Hospital from January 2018 to November 2020 were retrospectively selected as the study object(study group),and divided into two groups according to the left ventricular ejection fraction(LVEF)value.There were 31 patients with normal LVEF(group A),89 patients with LVEF decreased(group B).According to the New York Heart Association(NYHA)classification of cardiac function:21 cases of grade I,49 cases of gradeⅡ,31 cases of gradeⅢ,and 19 cases of gradeⅣ.And 80 healthy persons with similar ages during the same period were selected as the control group.The differences in LVEF,left ventricular end diastolic diameter(LVDD)and left atrium diameter(LAD)of the three groups of subjects were detected and their relationship with the classification of cardiac function were analyzed.Results The LVEF of the study group was(46.86±8.91)%,which was significantly lower than that of the control group[(69.85±7.47)%],and the LVDD and LAD were(56.57±7.44)mm and(47.67±7.31)mm,which were significantly higher than those of the control group[(49.93±5.13)mm,(22.95±6.05)mm],the differences were statistically significant(P<0.05).The LVEF in group A was(62.61±12.27)%,which was significantly higher than that in group B[(35.94±11.63)%],and the LVDD and LAD were(55.37±7.31)mm and(44.73±7.51)mm,which were lower than those in group B[(58.97±7.17)mm,(48.65±6.79)mm],the differences were statistically significant(P<0.05).The LVEF of patients with heart function gradesⅢandⅣwas significantly lower than that of patients with gradesⅠandⅡ,and LVDD and LAD were significantly lower than those of patients with gradeⅠandⅡ,the differences were statistically significant(P<0.05),however,there was no significant difference in LVEF,LVDD and LAD between patients with cardiac function class I and class II,classⅢand classⅣ(P>0.05).Conclusion Color Doppler echocardiography can dynamically display the heart structure,blood flow velocity and fluctuating velocity of patients.It can be used as an auxiliary means for the diagnosis,treatment evaluation and treatment plan adjustment of chronic heart failure with multiple causes,but it can not be used as a single basis for differential diagnosis.It should be systematically differentiated by combining with clinical symptoms,signs,etiology and history.