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目的:评估正常动脉血氧分压和无右心室衰竭迹象的慢性阻塞性肺疾病(COPD)患者心脏结构和功能。方法:25个COPD稳定期的患者(FEV1,1.23±0.52L/s;PaO2,82±10mmHg),26个与研究对象年龄匹配的受试者作为对照组。以超声多普勒超声心动图测定右心室(RV)和左心室(LV)的结构与功能及检肺动脉压(PAP)。结果:COPD组与对照组右心室舒张期末直径为19±3mm,23±2mm,(P<0.01),三尖瓣口舒张期血流速度比值为1.2±0.9,1.5±0.4(P<0.05);右心室壁舒张末期厚度为4±0.9,3±0.8,(P<0.05);右心室射血分数56±12,60±11(P>0.05)。COPD组与对照组左心室舒张期直径为48.0±5.5,46.2±3.4(P>0.05);二尖瓣口舒张期血流速度比值:1.2±0.4,1.5±0.9左心室后壁厚度为10.0±0.8,10.3±0.7(P>0.05);EF斜率55.5±11.7,54.5±12.1(P>0.05);左室舒张早期最大充盈速率分数为2.83±0.43,2.81±0.45(P>0.05);左心室射血分数53±7,62±14(P>0.05);COPD组与对照组均不伴有肺动脉高压。结论:心肌肥厚是COPD患者右心室压力超负荷最早迹象,这些心脏的适应性变化不改变左右心室的收缩功能。
PURPOSE: To assess the cardiac structure and function of patients with chronic obstructive pulmonary disease (COPD) with normal arterial oxygen tension and signs of right ventricular failure. Methods: Twenty-five patients with stable COPD (FEV1, 1.23 ± 0.52 L / s; PaO2, 82 ± 10 mmHg) and 26 age-matched subjects served as controls. The structure and function of right ventricle (RV) and left ventricle (LV) and pulmonary artery pressure (PAP) were measured by echocardiography. Results: The mean diastolic diameter of the right ventricle in COPD group and control group was 19 ± 3 mm and 23 ± 2 mm, respectively (P <0.01). The diastolic velocities of tricuspid valve were 1.2 ± 0.9 and 1.5 ± 0.4 (P <0.05) (P <0.05). The right ventricular ejection fraction was 56 ± 12,60 ± 11 (P> 0.05). The diastolic diameters of left ventricle in COPD group and control group were 48.0 ± 5.5 and 46.2 ± 3.4, respectively (P> 0.05). The diastolic velocities of mitral valve were 1.2 ± 0.4 and 1.5 ± 0.9, respectively. The thickness of left ventricular posterior wall was 10.0 ± (P> 0.05). The maximum rate of left ventricular diastolic filling rate was 2.83 ± 0.43 and 2.81 ± 0.45 respectively (P> 0.05) The ejection fraction was 53 ± 7,62 ± 14 (P> 0.05). The COPD group and the control group were not associated with pulmonary hypertension. Conclusion: Cardiac hypertrophy is the earliest sign of right ventricular pressure overload in patients with COPD. The adaptive changes of these hearts do not change the systolic function of left and right ventricles.