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等长运动对正常人、冠心病患者左室心功能的影响(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2000年第6期
页码:
446-449
栏目:
论著
出版日期:
2000-12-01

文章信息/Info

Title:
Assessment of left ventricular function in patients with coronary heart disease by isometric handgrip exercise
作者:
杨顺方1;  俞志昌1;  诸惠萍2;  倪幼芳3;  谢文辉1;  程建凡1;  马寄晓4
上海胸科医院: 11核医学科, 21心导管室, 31心内科, 上海200030; 41上海市第六人民医院
Author(s):
YANG Shun-fang;  YU Zhi-chang;  ZHU Hui-ping;  NY You-fang;  XIE Wen-hui;  CHENG Jian-fan;  MA Ji-xiao
Shanghai Chest Hospital, Shanghai 200030, China
关键词:
等长运动;  心脏功能试验;  冠状动脉疾病;  放射性核素显像
Keywords:
Isometric exercise;  heart function tests;  coronary disease;  radionuclide imag
分类号:
R540.47
DOI:
-
文献标识码:
A
摘要:
目的 通过核素心血池显像测定静息状态和等长运动后正常人、冠心病患者左室心功能指标的变化 ,探讨等长运动对冠心病诊断的临床价值。方法 45例正常人、10 0例冠心病患者常规核素平衡法门电路心血池显像测定左室心功能。在静息状态下采集后 ,保持探头和患者体位不变 ,双手握力 5～ 10 min并同时进行采集从而获得静息和握力运动状态下两组血流动力学指标和时间—放射性曲线。11例正常人和 10 0例冠心病患者行冠状动脉及左心室造影 ,两项检查间隔不超过两周。运用 SPSS9.0统计软件进行 t检验和直线相关分析。结果 左室射血分数(L VEF)、高峰充盈率 (PFR)、左室舒张末期容积 (L VEDV )、左室收缩末期容积 (L VESV )和心率 (HR)在静息(Rest)状态下 ,对照组和冠心病组分别为 (5 2± 9) % vs(4 5± 9% ) ,P<0 .0 1;2 .7± 0 .8EDV/s vs2 .0± 0 .8EDV/s,P<0 .0 1;1.33± 0 .12 vs 1.2 8± 0 .11,P <0 .0 5 ;0 .6 3± 0 .10 vs 0 .0 7± 0 .0 8,P<0.01; 7.0±10 min- 1 v s 69±9m in- 1, P>0.05。在等长握力运动(Stress) 状态下, 对照组和冠心病组分别为(56±10)% v s (42±10)%, P<0.01;3.1±0. 8 EDV/s v s 1. 8±0. 7 EDV/s. P <0.01; 1. 35±0. 14 v s 1. 25±0. 12, P < 0. 01; 0. 60±0. 12 v s 0. 73±0. 88,P<0.01; 83±3m in- 1 v s 79±12m in- 1, P > 0.05。LVEF, PFR ,LVEDV 和LV EDP 相关, 静息时相关系数分别为:r= - 0. 279, P = 0. 005; r= - 0. 271, P = 0. 006; r= - 0. 221, P = 0. 027. 运动时分别为: r= - 0. 365, P< 0. 01; r=- 0. 344, P <0.01; r=- 0.313, P = 0.002。结论 等长运动对冠心病患者既增加前负荷也增加后负荷, 但是主要增加后负荷。等长运动核素心血池显像和左室心功能测定用于评价冠心病患者收缩、舒张功能, 是一种准确、简便、有效的方法。
Abstract:
AIM To assess the influence of isometric handgrip exercise on left ventricular function by radionuclide angiography (RA) in patients with coronary heart disease (CHD). METHODS Using gated equilibrium radionuclide angiography,variables of left ventricular function were analyzed at rest and during supine handgrip exercise for 5~10 min in 45 normal control subjects and 100 consecutive CHD patients (at least 1 vessel with greater than or equal to 50% diameter narrowing) who were receiving therapy in a university teaching hospital setting. RESULTS At rest, the left ventricular ejection fraction (LVEF), peak filling rate (PFR), end-diastolic volume (EDV), end-systolic volume (ESV ) and heart rate (HR) were reduced in subjects with CHD (45±9)% , 2.0±0. 8 EDV/s, 1. 28±0. 11, 0. 07±0. 08, 69±9 min- 1, as compared with those of the controls (52±9)% , P<0.01, 2.7±0. 8 EDV/s, P <0.01, 1.33±0.12, P<0.05; 0. 63±0. 10, P <0.01; 70±10 m in- 1, P>0. 05. At handgrip exercise using both hands, the indexes were reduct in CHD patients (42±10)% , 1.83±0. 71 EDV/s, 1.25 ±0. 12, 0.73 ±0. 88, 79 ±12 m in- 1, as compared with those of the controls (56±10)% , P<0.01; 3.1±0. 8 (EDV/s) , P<0.01; 1.35±0. 14, P<0.01; 0. 60±0. 12, P < 0. 01; 83±13 m in- 1, P > 0. 05. LVEF, PFR and EDV were related to LVEDP by arteriography, both at rest ( r= - 0. 279, P= 0. 005; r= - 0. 271, P = 0. 006; r= - 0. 221, P = 0. 027 respect ively) and during handgrip ( r= - 0. 365, P < 0. 01; r= - 0. 344, P <0. 01; r= - 0. 313, P = 0. 002 respectively). These finding suggest that alterations in LV function during handgrip are importent determinants of clinical evaluation in patient with CHD. CONCLUSION The handgrip exercise increased not only afterload but also preload, but the main increment is in afterload. RA at rest and during handgrip exercise combined with pressure-volume loops is an accurate, effective method to evaluate CHD.

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备注/Memo

备注/Memo:
收稿日期：1999-12-06.
更新日期/Last Update: 2000-12-01