CAJ | 학술논문

目的：应用心音图舒张期时限/收缩期时限(D/S比值)评估慢性心力衰竭患者心力衰竭治疗前后的心功能情况,探讨心音图 D/S 比值在慢性心力衰竭患者治疗中的临床随访价值。方法收集重庆医科大学附属第一医院既往未正规治疗的CHF 患者48例,予以常规抗心力衰竭治疗并随访3个月。治疗前后分别记录患者 NYHA 心功能分级、静息心率(RHR)、D/S 比值、6 min 步行距离(6MWD)、左心室舒张末内径(LVEDd)及左心室射血分数(LVEF)。治疗3个月后以 RHR 65次/min 为界限,将 CHF 患者分为达标组与未达标组,比较各项指标治疗后的改善情况,比较 D/S 比值与常规心力衰竭评估指标的差异及各项指标与心功能缓解的关系。结果与用药前比较,除外 RHR,未达标组治疗1个月时各项指标均无显著改善,治疗3个月后D/S 比值、6MWD、LVEF 有显著改善(P <0.05)；达标组,治疗1个月时仅有 D/S 比值有显著改善(P <0.05),治疗3个月时各项指标均有显著改善(P <0.05)。两组组间比较,治疗1个月及3个月时 RHR 与 D/S 比值差异有统计学意义(P <0.05),LVEF 在治疗3个月时差异有统计学意义(P <0.05)。同时 D/S 比值与6MWD 同 NYHA 心功能分级呈显著负相关(P <0.05)。结论D/S 比值可反映 CHF 患者抗心力衰竭治疗后心功能改善情况,在 RHR 控制达标者中能更早更显著反映出心功能的改善,在CHF 患者抗心力衰竭治疗中具有良好的临床随访价值。
목적：응용심음도서장기시한/수축기시한(D/S비치)평고만성심력쇠갈환자심력쇠갈치료전후적심공능정황,탐토심음도 D/S 비치재만성심력쇠갈환자치료중적림상수방개치。방법수집중경의과대학부속제일의원기왕미정규치료적CHF 환자48례,여이상규항심력쇠갈치료병수방3개월。치료전후분별기록환자 NYHA 심공능분급、정식심솔(RHR)、D/S 비치、6 min 보행거리(6MWD)、좌심실서장말내경(LVEDd)급좌심실사혈분수(LVEF)。치료3개월후이 RHR 65차/min 위계한,장 CHF 환자분위체표조여미체표조,비교각항지표치료후적개선정황,비교 D/S 비치여상규심력쇠갈평고지표적차이급각항지표여심공능완해적관계。결과여용약전비교,제외 RHR,미체표조치료1개월시각항지표균무현저개선,치료3개월후D/S 비치、6MWD、LVEF 유현저개선(P <0.05)；체표조,치료1개월시부유 D/S 비치유현저개선(P <0.05),치료3개월시각항지표균유현저개선(P <0.05)。량조조간비교,치료1개월급3개월시 RHR 여 D/S 비치차이유통계학의의(P <0.05),LVEF 재치료3개월시차이유통계학의의(P <0.05)。동시 D/S 비치여6MWD 동 NYHA 심공능분급정현저부상관(P <0.05)。결론D/S 비치가반영 CHF 환자항심력쇠갈치료후심공능개선정황,재 RHR 공제체표자중능경조경현저반영출심공능적개선,재CHF 환자항심력쇠갈치료중구유량호적림상수방개치。
Objective To explore the follow-up value of phonocardiogram D/S ratio in CHF patients with treatment.Methods Forty-eight CHF patients who had never under-went regular treatment were collected in our hospital,given the regular anti-heart failure treatment for 3 months.NYHA heart failure classification,resting heart rate(RHR),and D/S ratio of phonocardiogram were recorded,six-minutes walk distance(6MWD),Left ventricular end diastolic diameter(LVEDd),the left ventricular ejection(LVEF) were tested before and after treatment.After 3-month treatment,the resting heart rate 65 times as the watershed,the patients were classified into two groups:one was up to standard,and the other was not up to standard.D/S ratio,RHR,6MWD,LVEDD,LVEF and the improvement of the heart function were compared between the two group.Results Exception the resting heart rate,the in-dicators had no significant improvement in the group of not up to standard compared with the before treatment,and D/S ratio, 6MWD,LVEF was improved significantly after three months treatment(P <0.05).In the group of up to standard,the D/S ratio was improved significantly after one months treatment(P <0.05),while after three months treatment all indicators were improved significantly(P <0.05).Comparison between the two groups,the RHR,D/S ratio were significantly improved(P <0.05 ),LVEF was significantly improved after three months treatment(P <0.05).At the same time,the D/S ratio,6MWD and NYHA classifica-tion of cardiac function was significant negatively correlated(P <0.05).Conclusion The D/S ratio could reflect heart functional im-provements in patients with CHF after anti-heart failure treatment,and it could reflect the heart functional improvement earlier and more significant in the group up to standard,it has a good clinic follow-up value in CHF patients with anti-heart failure treatment.