慢性心房颤动时上腔静脉血流动力学变化

目的　应用经胸超声心动图技术观察慢性心房颤动(房颤)时上腔静脉血流动力学的改变,探讨房颤对其血流频谱的影响及发生机制。方法　选择26例房颤患者和13 例窦性心律患者,采集上腔静脉多普勒血流频谱。测定上腔静脉收缩期S波、舒张早期D波和舒张晚期逆向 AR波的最大流速和流速积分;并与其他超声指标作相关性分析。结果　房颤时上腔静脉血流频谱各项指标与窦性心律组相比,收缩期 S波的峰值流速和流速积分显著降低(P<0.01);而舒张期 D波的峰值流速和流速积分无明显改变;舒张晚期逆向 AR波消失。上腔静脉收缩期S波峰值流速、流速积分与右房射血分数、右室射血分数、三尖瓣反流程度呈显著相关性(P<0.05~0.001)。舒张期D波峰值流速和流速积分与以上指标无显著相关性。结论　房颤时上腔静脉血流频谱形态明显改变,表现为舒张晚期逆向AR波消失;收缩期S波的峰值流速和流速积分较窦性心律时明显减小,舒张早期D波无明显变化,其血流频谱形态的改变很好地反映了右心压力的变化。

The hemodynamics of superior vena cava in chronic atrial fibrillation

Objective To investigate the changes and mechanisms of superior vena cava (SVC) hemodynamics in atrial fibrillation(AF).Methods Twenty six patients with chronic AF and 13 patients with sinus rhythm as control group were included.All patients underwent transthoracic echocardiography.The SVC flow velocity curve was recorded from the right superclavicular approach by placing the sample volume in the middle of the stream visualized by the color Doppler mode.The peak velocity and time-velocity integral of systolic waves,early diastolic waves,and late diastolic reversal waves were measured from the waveform of SVC flow.Results Compared to control group,the peak velocity and time-velocity integral of systolic waves in AF group decreased significantly (P< 0.01).There was no significant difference between two groups in peak velocity and time-velocity integral of early diastolic waves.The SVC Doppler flow in AF group was also characterised by the disappeared late diastolic reversal waves.Correlation of SVC flow in patients with AF showed that peak systolic wave velocity and time-velocity integral were correlated positively with RAEF and RVEF(P< 0.001),and negatively with tricuspid regurgitation(P< 0.05).Both peak velocity and time-velocity integral of early diastolic waves had no significant linear correlations with these index.Conclusions Doppler examination of SVC flow showed that the late diastolic reversal wave disappeared during AF,and the Doppler flow of SVC was composed of two waves: systolic wave and early diastolic wave.The changes of SVC Doppler flow was due to the alterations of right atrial and right ventricular pressure.