老年心力衰竭患者血管内皮舒张功能变化及临床意义

目的：通过对慢性心力衰竭（CHF）病人血流介导性肱动脉内皮舒张功能（FMD）的测定,探讨心衰病人FMD的变化及其与心力衰竭的关系和临床意义。方法：随机选择心衰患者50例,健康人20例。采用美国菲利普7500型超声心动图仪检测肱动脉基础状态下、反应性充血时（内皮依赖性舒张）及含服硝酸甘油后（非内皮依赖性舒张）的内径。计算反应性充血时肱动脉内径舒张百分比及含服硝酸甘油后肱动脉内径舒张百分比。结果：与正常组比较,心衰组FMD均显著降低（P〈0.05）,心功能越差,FMD降低越明显。结论：老年慢性心衰患者存在内皮功能障碍,改善内皮功能对于心力衰竭的防治具有重要临床意义。

The Changes in Vascular Endothelium in Elder Patients with Chronic Congestive Heart Failure and its Significance

Objective: To investigate the characteristics of flomediated dilation(FMD) of the brachial artery in patients with chronic heart failure(CHF).Methods:Fifty elderly patients with coronary heart disease accompanied with CHF,and 20 healthy controls were enrolled in this study.The inner diameter of the brachial artery was measured by B mode ultrasound at rest,during reactive hyperemic flow and after sublingual nitroglycerin.The dilatation percentage of inner diameter of the brachial artery at FMD and nitroglycerirr mediated dilation were calculated respectively.Results:The flow mediated dilation in all patients of CHF,and of the dilated cardiomyopathy was significantly lower than that in the control(P<0.05).The worse the cardiac function was in patients of CHF,the lower the flow-mediated dilation was respectively.Conclusion:Endothelial dysfunction is positively correlated with chronic heart failure.Endothelial dysfunction is correlated with the grade of CHF.FMD could be used as an indication of cardic function and has instructive value for the prognosis of heart failure.