Orchard R C, Craige E
Circulation. 1980 Nov;62(5):1107-14. doi: 10.1161/01.cir.62.5.1107.
Pre- and postoperative echophonocardiograms (EPCGs) and preoperative hemodynamic data of 108 patients who underwent valve replacement were reviewed to establish the frequency and significance of a dicrotic pulse (DP) postoperatively. DP occurred almost exclusively in patients who underwent valve replacement for regurgitant lesions (20 of 28 with aortic regurgitation, nine of 25 with mitral regurgitation, and four of six with both aortic and mitral regurgitation). These patients were divided into dicrotic and nondicrotic groups. Preoperatively, the dicrotic group had significantly larger end-diastolic volumes (p < 0.01) and end-systolic volumes (p < 0.01) and significantly lower ejection fractions (p < 0.01). Echocardiographically, the dicrotic group had larger left ventricular dimensions, both systolic (p < 0.01) and diastolic (p < 0.05), reduced percentage fractional shortening of the left ventricular cavity (p < 0.01) and poor thickening properties of the left ventricular posterior wall (% delta Th-LVPW) (p < 0.01). Postoperatively the dicrotic group had a slightly larger end-diastolic dimension (p = NS) and markedly depressed % delta Th-LVPW (p < 0.001) compared with the nondicrotic group. On follow-up EPCG the persistence of a DP correlated with continued left ventricular dysfunction by echocardiographic and hemodynamic studies and an extremely poor clinical course. DP after valve replacement is therefore an important prognostic sign.
回顾了108例行瓣膜置换术患者的术前和术后超声心动图（EPCG）以及术前血流动力学数据，以确定术后重搏脉（DP）的发生率及其意义。DP几乎仅发生在因反流性病变行瓣膜置换术的患者中（28例主动脉瓣反流患者中有20例，25例二尖瓣反流患者中有9例，主动脉瓣和二尖瓣反流均有的6例患者中有4例）。这些患者被分为重搏脉组和非重搏脉组。术前，重搏脉组的舒张末期容积（p<0.01）和收缩末期容积（p<0.01）显著更大，射血分数显著更低（p<0.01）。超声心动图显示，重搏脉组的左心室尺寸更大，包括收缩期（p<0.01）和舒张期（p<0.05），左心室腔缩短分数百分比降低（p<0.01），左心室后壁增厚特性较差（%δTh-LVPW）（p<0.01）。与非重搏脉组相比，术后重搏脉组的舒张末期内径略大（p=无统计学意义），%δTh-LVPW显著降低（p<0.001）。在随访EPCG中，DP的持续存在与超声心动图和血流动力学研究显示的持续左心室功能障碍以及极差的临床病程相关。因此，瓣膜置换术后的DP是一个重要的预后指标。
