老年舒张性心力衰竭患者的临床特点及心功能评价方法

摘要

目的 探讨老年舒张性心力衰竭患者临床特点及心功能评价方法.方法 选取我院干诊科老年舒张性心力衰竭患者290例(男215例,女75例).根据年龄、NYHA分级及基础疾病进行分组.经心脏超声测定左心室射血分数(LVEF)、二尖瓣口舒张期流速(早期/晚期)比值(E/A)、左心房内径(LAD)、左室舒张末内径(LVEDD),并测定血浆脑钠素(BNP)浓度.结果 NYHAⅡ级的患者最多,为195例(67.2％)；基础疾病中高血压病患者最多,为218例(75.2％).主要临床症状是乏力(77.6％)、呼吸困难(85.5％)和心悸(37.2％),主要的阳性体征为浮肿(42.7％)、肺部湿性罗音(31.7％).心律失常主要是房性早搏(67.6％)和房颤(29.5％).左心房增大的患者最多,为209例(72.1％),LAD为(46.2±4.6)mm,与左心房正常患者比较有统计学差异(P＜0.05);左心室正常最多,为235例(81.0％),LVEDD为(49.8±3.2)mm.左心房增大患者血浆BNP浓度为(279.45±62.82)pg/mL;左心室增大患者血浆BNP浓度为(345.96±78.32)pg/mL,与左心房、左心室正常患者比较有统计学差异(P＜0.001).患者血浆BNP浓度与E/A呈负相关(r=-0.62,P＜ 0.01),与LAD呈正相关(r=0.54,P＜ 0.01).结论 老年舒张性心力衰竭患者临床多伴有基础疾病,症状缺乏特异性.心脏超声检查结合血浆BNP浓度测定对心脏舒张功能的评价具有重要的临床意义.%Objective To discuss the clinical characteristics and cardiac function evaluation on the elderly patients with diastolic heart failure. Methods A total of 290 elderly patients with diastolic heart failure (215 male,75 female) were grouped according to the age, NY -HA classification and the fundamental disease. All patients were measured on LVEF, E/A, LAD, LVEDD by eehocardiography, as well as plasma brain natriuretic peptide (BNP) level. Results Totally 195 patients were classified into NYHA Ⅱ (67.2% ),accounting for the largest number in NYHA classification. The most common fundamental disease was hypertension, with a prevalence of 218 cases (75.2%). The most common clinical symptoms were fatigue (77.6%), dyspnea (85.5%)and tachycardia (37.2%). The major positive signs were edema (42.7%),moist roles in lungs (31.7%). Atrial premature and atrial fibrillation were the most common types of arrhythmia (67.6% and 29.5%). The examination on left atrium (LA) showed the number of patients with enlarged LA was the highest,being 209 case (72.1%), and LAD was 46.2±4.6 mm,with significant differences compared to normal LA patients. The examination on left ventricle (LV) revealed that the number of patients with normal LV was the highest,namely,235 cases (81.0%),and LVEDD was 49.8+3.2 mm. The average BNP level of patients with LA enlargement was 279.45±62.82 pg/mL. The average BNP level of patients with LV enlargement was 345.96±78.32 pg/mL,with significant differences compared to patients with normal LA and LV (P < 0.001). The BNP level correlated negatively with E/A (r =-0.62,P < 0.01 ),and positively with LAD (r =0.54,P < 0.01). Conclusion Most elderly patients with diastolic heart failure have many basic diseases, and with nonspecific symptoms and signs. It is of great significance to combine echocardiography with plasma BNP level to evaluate heart diastolic function in the elderly.