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目的探讨扩张型心肌病(DCM)患者心功能改变与脑血流动力学和认知功能变化关系及临床意义。方法DCM患者38例,健康体检者31例(对照组)。四维超声获取左心室射血分数(4D-EF)、每搏量(SV)、心输出量(CO)及左心室球形指数(SPI),计算心指数(CI)。颈部血管超声获得脑血流量(CBF)及平均阻力指数(M-RI)。采用简易精神状态评价量表(MMSE)评估DCM患者MMSE总分。分析心功能指标与脑血流及认知功能的关系。结果与对照组相比,病例组左房、左室明显扩大,SV、CO、CI明显升高,4D-EF显著下降,SPI明显增大(P<0.01);CBF无明显减少,脑血管M-RI明显减低(P<0.05),随4D-EF减低,M-RI及MMSE总分均明显下降(P均<0.01),4D-EF与CBF无显著相关性。结论DCM患者即使心输出量和脑血流量无显著减低时,脑血管阻力已经下降,认知功能发生异常,且随心力衰竭程度加大,认知功能损害加重,提示DCM患者临床早期综合干预治疗对改善预后有重要意义。
Objective To investigate the relationship between cardiac function changes and cerebral hemodynamics and cognitive function in patients with dilated cardiomyopathy (DCM) and its clinical significance. Methods 38 cases of DCM patients, 31 healthy subjects (control group). The left ventricular ejection fraction (4D-EF), stroke volume (SV), cardiac output (CO) and left ventricular spherical index (SPI) were obtained by four- Cerebral blood flow (CBF) and mean resistance index (M-RI) were obtained by ultrasound in the neck vessels. MMSE was used to assess MMSE score in patients with DCM. To analyze the relationship between cardiac function and cerebral blood flow and cognitive function. Results Compared with the control group, left atrium and left ventricle were significantly enlarged in the case group, SV, CO and CI were significantly increased, 4D-EF significantly decreased, SPI significantly increased (P <0.01); CBF was not significantly reduced, cerebrovascular M (P <0.05). The scores of M-RI and MMSE were significantly decreased with the decrease of 4D-EF (all P <0.01). There was no significant correlation between 4D-EF and CBF. Conclusion Even if the cardiac output and cerebral blood flow were not significantly reduced, DCM patients had decreased cerebral vascular resistance and abnormal cognitive function. With the increase of heart failure, the impairment of cognitive function aggravated the DCM patients’ clinical early comprehensive intervention To improve the prognosis of great significance.