心力衰竭合并永久性房颤患者血流动力学特点分析

Analysis of hemodynamic characteristics in heart failure patients with permanent atrial fibrillation

目的利用经胸阻抗心动图评价心力衰竭伴永久性房颤患者的血流动力学特点。方法回顾性分析233例经胸阻抗心动图监测的受试对象的临床资料,根据纳入及排除标准排除141例受试者,最终纳入的46例心力衰竭合并永久性房颤患者作为心力衰竭合并永久性房颤组,46例健康受试者作为正常对照组。统计并比较两组受试者临床基线资料及经胸阻抗心动图的血流动力学结果。结果两组的年龄、性别、体质量指数(BMI)、平均心室率、平均收缩压、平均舒张压、平均动脉压、高血压病、糖尿病、谷丙转氨酶、肌酐清除率、总胆固醇、低密度脂蛋白胆固醇比较差异均无统计学意义(P>0.05)。心力衰竭伴永久性房颤组的心输出量、心脏指数、心率变律性、胸液传导性、系统阻力、每搏外周阻力指数、射血前期、左心室射血时间分别为1.95(0.70)L/min、1.10(0.50)L/(min·m^(2))、-211.00(122.00)%、27.00(6.00)1/kΩ、308.03(136.35)kPa·s/L、406.60(176.20)dyne·s/(cm5·beat·m^(2))、82.00(21.00)ms、291.50(31.00)ms,正常对照组分别为3.60(1.60)L/min、2.10(0.80)L/(min·m^(2))、-67.00(71.00)%、26.00(5.00)1/kΩ、163.01(112.48)kPa·s/L、190.25(144.10)dyne·s/(cm5·beat·m^(2))、77.00(11.00)ms、309.50(31.00)ms。心力衰竭伴永久性房颤组的心输出量、心脏指数、心率变律性均低于正常对照组,系统阻力、每搏外周阻力指数均高于正常对照组,射血前期长于正常对照组,左心室射血时间短于正常对照组,差异具有统计学意义(P<0.05)。两组胸液传导性比较差异无统计学意义(P>0.05)。结论心力衰竭合并永久性房颤患者心输出量及心脏指数明显下降,系统阻力及每搏外周阻力指数明显升高,射血前期延长及左心室射血时间缩短,同时心率变律性更低。

Objective To evaluate the hemodynamic characteristics of heart failure patients with permanent atrial fibrillation by transthoracic impedance cardiography.Methods The clinical data of 233 subjects with transthoracic impedance cardiography were retrospectively analyzed.According to the inclusion and exclusion criteria,141 subjects were excluded,46 patients with heart failure combined with permanent atrial fibrillation were included as the heart failure with permanent atrial fibrillation group,and 46 healthy subjects were included as the normal control group.The clinical baseline data and hemodynamic results of transthoracic impedance cardiography were compared between the two groups.Results There were no statistically significant differences in terms of age,gender,BMI,mean ventricular rate,mean systolic blood pressure,mean diastolic blood pressure,mean arterial pressure,hypertension,diabetes,alanine transaminase,creatinine clearance rate,total cholesterol and low density lipoprotein cholesterol between the two groups(P>0.05).The cardiac output,cardiac index,heart rate variability,thoracic fluid conductivity,systemic resistance,stroke systemic vascular resistance,pre-ejection period and left ventricular ejection time of heart failure with permanent atrial fibrillation group were 1.95(0.70)L/min,1.10(0.50)L/(min·m^(2)),-211.00(122.00)%,27.00(6.00)1/kΩ,308.03(136.35)kPa·s/L,406.60(176.20)dyne·s/(cm5·beat·m^(2)),82.00(21.00)ms and 291.50(31.00)ms,and those of the normal control group were 3.60(1.60)L/min,2.10(0.80)L/(min·m^(2)),-67.00(71.00)%,26.00(5.00)1/kΩ,163.01(112.48)kPa·s/L,190.25(144.10)dyne·s/(cm5·beat·m^(2)),77.00(11.00)ms and 309.50(31.00)ms.The cardiac output,cardiac index and heart rate variability in the heart failure with permanent atrial fibrillation group were lower than those in the normal control group;the systemic resistance and stroke systemic vascular resistance were higher than those in the normal control group;the pre-ejection period was longer than that in the normal control group;the left ventricular ejection time was shorter than that in normal control group;the differences were statistically significant(P<0.05).There was no statistically significant difference in thoracic fluid conductivity between the two groups(P>0.05).Conclusion Heart failure Patients with permanent atrial fibrillation possess a significant decrease in cardiac output and cardiac index and an increase in systemic resistance and systemic vascular resistance index,a more extended pre-ejection period and shorter left ventricular ejection time,accompanied by a lower heart rate variability.