慢性心力衰竭患者心室重塑及其相关血流动力学指标的变化

目的 分析慢性心力衰竭患者心室重塑及相关血流动力学指标的变化,探讨抗心室重塑及改善血流动力学指标在慢性心衰患者临床治疗中的意义.方法 选择2015年12月至2016年3月在我院接受治疗并符合纳入条件的慢性心衰患者124例,对所有患者入组时的心室重塑相关指标[左心射血分数(LVEF)、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、缩短分数(FS)]和血流动力学指标[(心率(HR)、动脉收缩压(SAP)、动脉舒张压(DAP)及左室收缩期压力(LVSP)、左心室舒张末压(LVEDP)]进行检测,并将结果按照心衰的严重程度(Ⅱ~Ⅳ级)分组统计并比较,所有患者均参照2014年《中国慢性心力衰竭诊断和治疗指南》对患者进行治疗,比较患者治疗前后心室重塑相关指标和血流动力学指标的变化,并采用明尼苏达心力衰竭生活质量调查量表(MLHFQ)对患者治疗前后的生活质量评分进行调查,将每位患者的MLHFQ评分和心室重塑指标和血流动力学指标分别输入Pearson相关性评价程序,计算MLHFQ评分和心室重塑指标及血流动力学指标间的相关性.结果 不同心衰严重程度的患者其心室重塑指标、血流动力学指标和MLHFQ评分比较,随着心衰程度的加重,LVEF、FS、LVSP明显降低,LVESD、LVEDD、SBP、HR、LVEDP及MLHFQ评分明显增加,不同心衰程度间比较,差异均有统计学意义(P<0.05);治疗3个月后,患者的心室重塑指标LVEF、FS明显升高,LVESD、LVEDD明显降低,血流动力学指标LVSP明显升高,SBP、HR及LVEDP明显降低,MLHFQ评分均值较治疗前有明显改善,差异均有统计学意义(P<0.05);MLHFQ评分与心室重塑指标LVESD(r=0.641)、LVEDD(r=0.593)呈正相关,与FS(r=-0.724)、LVEF(r=-0.716)呈负相关;与血流动力学指标SBP(r=0.549)、HR(r=0.497)、LVEDP(r=0.693)呈正相关,与LVSP(r=-0.705)呈负相关.结论 慢性心力衰竭患者心室重塑和血流动力学指标随着患者病情严重程度及采取治疗措施而改变,上述指标的可量化性为慢性心力衰竭患者的临床诊断和治疗效果评估提供了方向,对指导患者治疗方案选择及调整具有重要临床意义.

Ventricular remodeling and associated hemodynamic changes in patients with chronic heart failure

Objective To investigate the changes of ventricular remodeling and associated hemodynamic index in patients with chronic heart failure, and to explore the significance of anti-ventricular remodeling and improved hemo-dynamics in treating chronic heart failure patients. Methods A total of 124 patients with chronic heart failure who were treated in our hospital between December 2015 and March 2016 and met all inclusion criteria were enrolled in the study. Serial ventricular remodeling indexes [left ventricular ejection fraction (LVEF), left ventricular end systolic diameter (LVESD), left ventricular end diastolic diameter (LVEDD), shortened fraction (FS)] and hemodynamic indicators [heart rate (HR), systolic blood pressure (SAP), diastolic arterial pressure (DAP) and left ventricular systolic pressure (LVSP), left ventricular end diastolic pressure (LVEDP)] were detected. The results were grouped and compared according to sever-ity of heart failure (Ⅱ~Ⅳ), and all patients were treated based on the"China Guidelines for the Diagnosis and Treatment of Chronic Heart Failure 2014". The changes of ventricular remodeling and hemodynamic parameters were compared be-fore and after treatment. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) was used to assess quality of life before and after treatment. The total MLHFQ scores, ventricular remodeling indexes and hemodynamic indicators were analyzed using SPSS software, and Pearson correlation coefficient will be calculated between the above groups. Results According to ventricular remodeling, hemodynamic and MLHFQ scores in different severity of heart failure in patients differed significantly. With the aggravation of heart failure, LVEF, FS and LVSP decreased, while LVESD, LVEDD, SBP, HR, LVEDP and MLHFQ were increased, with statistically significant differences (P<0.05). After 3 months of treatment, the ventricular remodeling index LVEF, FS increased, while LVESD and LVEDD decreased;hemo-dynamic index LVSP increased, and SBP, HR and LVEDP decreased;mean MLHFQ score improved significantly com-pared with before treatment; all these differences were statistically significant (P<0.05). The score from the MLHFQ showed a positive correlation with LVESD (r=0.641), LVEDD (r=0.593), a negative correlation with FS (r=-0.724), LVEF (r=-0.716) in ventricle remodeling index;and a positive correlation with SBP (r=0.549), HR (r=0.497), LVEDP (r=0.693), a negative correlation with LVSP (r=-0.705) in hemodynamic index. Conclusion The indexes of ventricular re-modeling and hemodynamics in patients with chronic heart failure changed with the severity of the disease and the treat-ment. Quantification of the above indicators provides the direction for clinical diagnosis and treatment evaluation in chron-ic heart failure patients. It has important clinical significance for guiding the selection and adjustment of treatment plan.