心力衰竭患者静态心率，二尖瓣反流与心脏功能变化：室内传导阻滞的影响.docVIP

心力衰竭患者静态心率，二尖瓣反流与心脏功能变化：室内传导阻滞的影响 　　【摘 要】目的：心力衰竭是临床上常见心血管重症. 静态心率增快和功能性二尖瓣反流是心力衰竭的临床表现。但是心力衰竭患者静态心率和功能性瓣膜反流发生和心功能变化并不完全明了。尤其是在合并有室内传导阻滞的心力衰竭患者。本研究目的是观察伴有和不伴有室内传导阻滞的心力衰竭患者静态心率和二尖瓣反流和心功能变化。 对象和方法： 92例心力衰竭患者收缩功能降低（LVEF50%），其中扩张性心肌病61例，缺血性心肌病31例 其中，无室内传导阻滞患者 52例，有室内传导阻滞患者40例。55例正常人为对照组. 所有病人进行包括M-型和二维及彩色多普勒超声检查。结果：与正常对照组比较，在心力衰竭伴有或不伴有室内传导阻滞的患者，静态心率明显增快。 心力衰竭无室内传导阻滞患者，57%患者有二尖瓣反流。在心力衰竭有室内传导阻滞的患者，92%的患者有二尖瓣反流，二尖瓣反流时间明显延长，尤其是射血前期和舒张早期二尖瓣反流明显延长。每分钟总等容时间明显延长和总充盈时间明显缩短。随访结果。在心力衰竭伴室内传导阻滞患者，心脏事件（安装起搏器，左心室辅助装置，心脏移植）和死亡率较无室内传导阻滞的心力衰竭患者明显增加。结论：收缩功能降低的心力衰竭患者，静态心率增快十分常见，大多数患者有二尖瓣反流，尤其是伴有室内传导阻滞，二尖瓣反流时间明显延长，总等容时间延长，总充盈时间缩短。在药物优化治疗的基础上进行双心室再同步治疗可以减轻二尖瓣反流，改善心脏功能。 　　【关键词】静态心率；二尖瓣反流；心力衰竭；超声心动图描记术；多谱勒 　　【文章编号】1004-7484（2014）07-4212-02 　　【Abstract】Objectives： Resting heart rate and Mitral regurgitation（MR） are frequently abnormal in clinical heart failure. The aims of this study were to examine the frequency of functional MR and to investigate the resting heart rate and MR as well as left ventricular performance in these patients .Subjects and method： 55 normal subjects， 52 patients with heart failure and normal intraventricular conduction and 40 heart failure patients with intraventricular conduction delay underwent Doppler echocardiographic examianation，Results： Compared with normal subjects ，resting heart rate were increased in heart failiue patients with or without intraventricular conduction delay . 3 normal subjects had mild functional MR， 57%（30/52） patients with heart failure and normal conduction had functional MR， 92%（37/40） functional MR were detected in patients with heart failure and intraventricular conduction delay. LV total isovolumic time per minute increased and total filling time per minute were reduced in such patients（p0.01）. Conclusion ： In patient with heart failure， resting heart rate were significant increased. MR was common in patients with heart failure with intraventricular conduction delay. Total diastolic and filling time were significant reduced。 Left