【作者】 韩淑杰；

【导师】 杨俊华；

【作者基本信息】 苏州大学 ， 内科学， 2010， 硕士

【摘要】 【目的】:应用超声心动图综合参数评价慢性心力衰竭患者的整体心脏功能,并对慢性心衰患者治疗效果进行评价。【方法】:前瞻性研究慢性心力衰竭患者101例,其中随访组72例,非随访组29例,正常对照组30例,应用超声心动图综合参数组成的心衰超声指数进行评分,测定BNP,进行纽约心功能分级。对随访组与非随访组分别于3、6个月进行超声心动图检查,重新进行心衰超声指数评分。1.分析心衰超声指数诊断慢性心力衰竭的敏感性、特异性、阳性预测值、阴性预测值,与血浆BNP、纽约心功能分级之间的相关性。2.分析随访组与非随访组心衰超声指数变化。3.观察合理的教育管理、规范的药物应用对慢性心衰患者治疗效果的影响。【结果】:1.心衰超声指数可用于慢性心衰患者的整体心功能的评价。当心衰超声指数值≥3时,其诊断慢性有症状性心力衰竭的敏感性、特异性、阳性预测值、阴性预测值分别为95%、96%、98%、81%。心衰超声指数与血浆BNP水平呈正相关(r=0.680),其相关系数相似于NYHA心功能与BNP的相关系数(r=0.730),并高于Tei指数与血浆BNP的相关系数(r=0.590);心衰超声指数、Tei指数与纽约心功能分级呈正相关(r分别为0.663、0.652),两者相关系数相似。超声心动图参数中左房容积、左室收缩末期内径、左室射血分数、二尖瓣E峰峰值流速、二尖瓣E峰减速时间、二尖瓣EA比值与BNP均有相关性。2.随访组治疗6个月后心衰超声指数明显下降,其中首先改善的是左室舒张功能及肺动脉压力参数。3.治疗后6个月随访组与非随访组心衰超声指数、NYHA心功能之间差异有统计学意义。【结论】:心衰超声指数可用于慢性心衰患者的整体心功能的诊断,指导慢性心衰患者的治疗,评价治疗效果及预后。合适健康教育和规范化用药可提高慢性心力衰竭的治疗效果,改善患者的生活质量。更多还原

【Abstract】 【Objective】: Using echocardiographic multi-parameters, we evaluate the heart function and the effect of the treatment of patients with chronic heart failure (CHF).【Methods】: Prospectively we studied 101 patients with CHF, 72 cases in follow-up group, 29 cases in non-follow-up group, and 30 in normal control group. All the subjects were scored by heart failure echochardiographic index (HFEI) which synthesized the parameter of echocardiography, and measured the cardiac functional grading by NHYA, BNP, Tei index. All the 101 patients were scored by HFEI after 3 and 6 months therapy respectively, which were as follows: 1. Analyzing the sensitivity, specificity, positive value and negative value of HFEI to diagnose chronic heart failure. Studying the correlation among HFEI, the level of BNP and the cardiac functional grading by NHYA. 2. Analyzing the changes of HFEI before and after treatment in follow-up group and non-follow-up group. 3. Observing the effect of suitable management and strictly medicine taken on patients with chronic heart failure.【Results】: 1. It was valuable to diagnose CHF and evaluate the degree of the CHF with HFEI. When HFEI≥3, the sensitivity, specificity, positive value and negative value of HFEI for diagnosing CHF was 95%、96%、98%、81% respectively. The HFEI of the CHF group was significantly higher than control group. HEFI was positively correlated with BNP (r=0.680) and the cardiac functional grading by NHYA (r=0.663). Compared with other parameters of echocardiography, there was remarkable correlation between BNP and LAV, ESV, LVEF, E, DT, E/A. 2. After 3 months, indexes of left ventricular diastolic function and pulmonary artery pressure were changed firstly. After 6 months, HFEI decreased significantly in follow-up group. 3. HFEI and the cardiac functional grading by NHYA in follow-up group were significantly lower than non-follow-up group. 【Conclusions】: It is valuable to diagnose CHF, evaluate the degree of the CHF and judge the overcome of treatment also. Suitable management and strictly medicine taken on patients with chronic heart failure can improve the overcome of treatment and quality of life.更多还原