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无创性(非侵入性)心脏检查技术是近年来发展最为迅速的诊断技术之一,不仅被广泛地用于诊断和评价各种心血管疾病,而且是评价心功能状态、观察病情、疗效考核和估价预后的极有用的方法。由于无创性心脏检查技术的长足进展,目前创伤性心脏检查技术,如左、右心导管检查术、选择性心血管造影术以及冠状动脉造影术已大为减少。创伤性心脏检查技术要经静脉或动脉插入心导管,需要设备多,操作技术要求高,费用昂贵,且不能多次重复检查均为其缺点,有时尚可能引起某些并发症,在少数情况下,甚至可致残或造成死亡。按目前国内条件,这些创伤性技术在基层单位尚难开展,而一般无创性心脏检查技术设备较为简单,对病人损害不大也无痛苦,且可多次重复检查,均为其优点,较适合于基层单位开展心功能检查。广义来讲,无创性心脏检查技术范围很广,种类繁多,包括常规体表心电图、动态心电图、体表等电位标测(胸前多电极描记技术)、心向量图、心音图、超声心动图(包括M型、二维、三维和多普勒超声心动图)、心尖搏动图、心阻抗图、颈动脉波、体表希氏束电图、食管心房调搏技术、普通X线检查、电子计算机X线断层扫描(CT)、核磁共振显象以及放射性核素技术等。鉴于本刊读者主要对象是基层医务人员,故本讲座着重介绍常用的、基层容易开展的无创性心脏检查技术,对于较为新尖的或要求设备多、费用昂贵而基层目前难以开展的项目只作一般知识性介绍,便于读者掌握其应用范围和主要适应症,以便需要向上级医疗单位转送病人时,还应做那些检查心中有数。本讲座对于教科书或有关书籍已有较为广泛介绍的检查项目,仅着重介绍临床应用价值及其评价。M型和二维超声心动图的临床应用,本刊曾于1983年5～10期作过连载讲座,为避免重复仅着重介绍对心功能检查的价值及其应用。无创性心脏检查技术目前正处于方兴未艾阶段,它作为诊断心血管疾病的一种手段,既要看到它在心血管疾病中的诊断价值,也要看到它不足和局限性的一面,对其检测结果也应实事求是地作客观的综合分析,这样就能够在临床实践中更好地发挥它应有的作用。
Noninvasive (noninvasive) cardiac examination is one of the most rapidly developed diagnostic techniques in recent years. It is widely used not only in the diagnosis and evaluation of various cardiovascular diseases, but also in assessing the status of cardiac function, observing the condition, assessing the curative effect and Valuable prognosis is a very useful way. Due to advances in non-invasive cardiac examinations, traumatic cardiac examinations such as left and right heart catheterization, selective cardiovascular angiography, and coronary angiography have been greatly reduced. Traumatic cardiac examinations require intravenous or arterial catheterization of the heart catheterization, require more equipment, technical requirements for operation, expensive, and can not be repeated multiple checks are their shortcomings, some fashion may cause some complications, in a few cases , Can even cause disability or death. According to the current domestic conditions, these traumatic technologies are still difficult to carry out in the grass-roots units. However, the general noninvasive cardiac examination equipment is relatively simple and has little or no detrimental impact on the patient and can be repeated for many times, both of which are more suitable At the grass-roots units to carry out cardiac function tests. In a broad sense, noninvasive cardiac examinations cover a wide range of techniques including conventional surface electrocardiogram, ambulatory electrocardiogram, body surface equipotential mapping (plethysmography), cardiogram, phonocardiogram, echocardiogram (Including M type, two dimensional, three dimensional and Doppler echocardiography), apex beat chart, cardiac impedance chart, carotid artery wave, body surface His bundle, esophageal atrial pacing technique, general X ray examination, electronic Computer tomography (CT), magnetic resonance imaging and radionuclide technology. In view of the fact that our readership is mainly targeted at grassroots medical personnel, this lecture focuses on commonly used non-invasive cardiac examinations that are easy to carry out at the grassroots level. For projects that are relatively new or require more equipment and are expensive and are currently difficult to carry out, General knowledge of the introduction to facilitate readers to grasp the scope of its application and the main indications in order to transfer the patient to the higher medical units, but also those who do check those in mind. This lecture for textbooks or related books have been more extensive examination of the project, focusing only on the clinical application of value and its evaluation. M-type and two-dimensional echocardiographic clinical applications, we published in 5 to 10 in 1983 serialized lectures, in order to avoid duplication of emphasis only on the value of cardiac function tests and its application. Noninvasive cardiac examination is currently in its ascendant phase. As a means of diagnosing cardiovascular diseases, it not only needs to see its diagnostic value in cardiovascular diseases, but also its insufficiency and limitation. The results should also be realistic and objective analysis of the objective, so that we can better play its due role in clinical practice.