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目的观察慢性心力衰竭(CHF)不同进展阶段患者无创血流动力学指标的变化规律,探讨其相关指标检测的临床实用意义。方法选取空军总医院2014年3月~2016年10月心脏中心住院的119例患者,按照美国心脏病学学会/美国心脏病协会(American College of Cardiology/American Heart Association,ACC/AHA)心衰进展分期标准将其分为A、B、C期,A期即前心衰阶段(A组),B期即前心衰临床阶段(B组),C期即临床心衰阶段(C组)。另选同期来院健康体检者39例作为正常对照组(O组)。收集患者临床资料,并采集外周静脉血,检测血清B型利钠肽(BNP)水平,行心脏超声,记录左心室射血分数(LVEF)值,同时行无创血流动力学检测,记录无创血流动力学心功能指标,包括心搏出量(SV)、心输出量(CO)、心脏指数(CI)、室缩波波幅(C波波幅,C);心缩力指数(HI)、收缩功能指数(Q-B/B-X);肺动脉楔压(PCWP)、左心室舒张末压(LVEDP);主动脉顺应性(AC)、总外周阻力(TPR)。比较分析CHF不同进展阶段无创血流动力学指标及BNP、LVEF的变化。结果与对照组相比,A~C 3组无创血流动力学C、SV、CO、CI、HI、AC指标值降低(P<0.05),Q-B/B-X、PCWP、LVEDP指标值升高(P<0.05);心衰不同进展阶段各组进一步两两比较显示,除CO、AC在A、B组之间无差异外,其余指标差异均具有统计学意义(P<0.05);C、SV、CO、CI、HI、AC随心衰不同进展阶段而降低(P<0.05),而C、CI、HI降低更显著;Q-B/B-X、PCWP、LVEDP随心衰不同进展阶段而增高(P<0.05),而Q-B/B-X增高更显著。BNP在C组比正常对照组、A组和B组明显升高(P<0.05),但A、B组之间,A、B组和O组之间有升高的趋势,无统计学意义(P>0.05);LVEF在C组较O组、A组和B组明显降低(P<0.05),在A、B组之间,A、B和O组之间有下降的趋势,无统计学意义(P>0.05)。经相关性分析无创血流动力学指标C、SV、CO、CI、HI、AC、LVEF均与心衰不同进展阶段呈负相关,Q-B/B-X、PCWP、LVEDP、TPR、BNP与心衰不同进展阶段呈正相关。为进一步分析无创血流动力学指标对心衰A、B期心功能的评估能力行ROC曲线分析,结果发现HI,Q-B/B-X指标曲线下面积均优于其余指标。结论无创血流动力学相关指标的变化与心衰不同进展阶段有一致性,可为临床心衰早期评估心功能提供客观参考指标。
Objective To observe the variation of noninvasive hemodynamic parameters in patients with different stages of chronic heart failure (CHF) and to explore the clinical significance of the detection of related indexes. Methods A total of 119 patients hospitalized in the Air Force General Hospital from March 2014 to October 2016 were selected according to the American College of Cardiology / American Heart Association (ACC / AHA) Staging criteria were divided into A, B, C period, A period is the former heart failure stage (A group), B stage is the clinical stage of pre-heart failure (B group), C phase is the clinical heart failure stage (C group). In the same period, 39 healthy subjects were hospitalized as normal control group (O group). The clinical data of patients were collected and peripheral venous blood was collected. The level of serum BNP was measured. Cardiac echocardiography was performed and the left ventricular ejection fraction (LVEF) was recorded. Meanwhile, non-invasive hemodynamic tests were performed to record noninvasive blood The cardiac function indexes of flow mechanics including cardiac output (SV), cardiac output (CO), cardiac index (CI), ventricular contractility wave amplitude (C wave amplitude, C), cardiac contractility index (HI) Function index (QB / BX); Pulmonary artery wedge pressure (PCWP), Left ventricular end diastolic pressure (LVEDP); Aortic compliance (AC) and total peripheral resistance (TPR). Comparative analysis of non-invasive hemodynamic parameters and BNP, LVEF changes in different stages of CHF. Results Compared with the control group, the indexes of C, SV, CO, CI, HI and AC decreased (P <0.05) and the indexes of QB / BX, PCWP and LVEDP increased <0.05). Further comparison of each group in different progression stages of heart failure showed that the difference of other indexes were statistically significant except for CO and AC in group A and group B (P <0.05); C, SV, CO, CI, HI and AC decreased with different stages of heart failure (P <0.05), while C, CI and HI decreased more significantly; QB / BX, PCWP and LVEDP increased with different stages of heart failure ), While QB / BX increased more significantly. BNP in C group was significantly higher than that in normal control group, A group and B group (P <0.05), but no significant difference was found between A, B group, A, B group and O group (P> 0.05). LVEF in group C was significantly lower than that in group O, group A and group B (P <0.05), but there was no statistical difference between group A and group B Significance (P> 0.05). Correlation analysis showed that noninvasive hemodynamic parameters C, SV, CO, CI, HI, AC, LVEF were negatively correlated with different stages of heart failure, and QB / BX, PCWP, LVEDP, TPR, Stage is positively correlated. To further analyze the assessment of heart function of noninvasive hemodynamic parameters in heart failure at A and B phases, ROC curve analysis was performed. The results showed that the areas under HI and Q-B / B-X index curves were better than the rest. Conclusions The changes of noninvasive hemodynamic indices are consistent with the different stages of heart failure, which can provide an objective reference for early assessment of cardiac function in clinical heart failure.