应用超声初步探讨高血压患者心-血管耦联

摘要

目的 应用超声评价高血压患者心脏、血管弹性变化及二者弹性匹配关系,初步探讨心-血管耦联.方法 原发性高血压患者50例,年龄和性别相匹配的30例受试者作为对照组.采用超声心动图法获取左室结构、功能和血流动力学参数,测量平静状态下肱动脉血压和颈-股脉搏波传播速度.计算心脏、大动脉弹性及两者耦联的相应参数:心室收缩末压(ESP)、有效动脉弹性(Ea)、心室舒张末弹性(Ed)、左室收缩末弹性(Ees)和Ea/Ees.结果 Ees与左室射血分数(r=0.378,P=0.005)、Ea与颈-股脉搏波传播速度(r=0.289,P＜0.001)均呈正相关,Ed与e/a(r=- 0.333,P=0.027)呈负相关,左室后壁厚度与Ed和Ea呈正相关(r=0.388,P=0.016和r=0.336,P=0.026).高血压组的Ea和Ed较对照组明显增高(P＜0.05),Ees和Ea/Ees两组差异无统计学意义(P＞0.05).结论 高血压患者动脉与心脏弹性变化相互关联,两者的匹配可评价心-血管耦联.%Objective To evaluate the cardiovascular stiffness and its coupling of patients with hypertension by ultrasound.Methods Fifty patients with essential hypertension and 30 age- and gendermatched subjects without hypertension,diabetes and other cardiovascular diseases as control group were enrolled in this study.The parameters of structure and function of left ventricle,blood flow were measured by echocardiography.The blood pressure and carotid-femoral pulse wave velocity (CFPWV) were also measured.The derived corresponding parameter:end-systolic pressure(ESP),effective arterial elastance (Ea),end-diastolic (Ed),end-systolic ventricular elastance (Ees) and Ea/ Ees were calculated respectively.Results Ees was correlated positively with ejection fraction (r =0.378,P =0.005),while Ea was correlated positively with CFPWV( r =0.289,P ＜0.001).Ed was correlated negatively with e/a ( r =- 0.333,P =0.027).Posterior wall of left ventricle was correlated positively with Ed and Ea( r =0.388,P =0.016; r =0.336,P =0.026).Ea and Ed in patients with hypertension were significantly higher than those in control group( P ＜0.05),but there was no significant difference of Ees and Ea/ Ees between two groups( P ＞ 0.05).Conclusions Arterial stiffness is associated with ventricular stiffness,and their matching relation can be applied to evaluate ventricular-arterial coupling.