CAJ | 학술논문

目的采用M型超声、二维超声（2DE）及实时三维超声（RT3DE）对患有法洛四联症（TOF）的婴幼儿进行左心收缩功能评估及对比研究，探讨各方法对TOF患儿围手术期左心室收缩功能评估的可行性及局限性，以期指导临床应用。方法选取在我院确诊为TOF且年龄小于4周岁的患儿102例（术前54例，术后2～3 d 48例），分别采用M型超声、2DE引导下的双平面Simpson法、RT3DE引导下的双平面Simp-son法以及RT3DE全容积重建法测量TOF患儿左心室射血分数（LVEF），对比以上方法与RT3DE全容积重建法测值的一致性及各方法的重复性。结果2DE引导下的双平面Simpson法和RT3DE引导下的双平面Simpson法所测LVEF与RT3DE全容积重建法测值一致性较好（R值分别为0.38和0.96，P＜0.001），而M型超声测值与RT3DE全容积重建法无显著相关性（P＝0.11），进一步将病例分为术前及术后两组发现，术前M型超声测值与RT3DE全容积重建测值一致性较好（R＝0.37，P＝0.008），而术后M型测值与RT3DE全容积重建测值无显著相关性（P＝0.083）。相比全容积重建法，RT3DE引导下的双平面Simpson法低估左心室舒张末容积。 RT3DE所测左心室舒张末容积（ LVEDV）和LVEF，三维引导下的Simpson法、二维引导下的Simpson法以及M型超声所测LVEF的观察者内变异分别为（7±4）％，（6±3）％，（4±2）％，（10±7）％，（6±3）％；观察者间变异分别为（15±6）％，（10±5）％，（7±5）％，（14±11）％，（11±4）％。结论 RT3DE引导下的双平面Simpson法及RT3DE全容积重建法对TOF围手术期左心室功能评估具有较高的可行性，2DE引导下的双平面Simpson法次之；而M型超声总体评估效果较差，并主要体现在对TOF术后患儿的心功能评估上。各测量方法重复性均在临床可接受范围内。
목적채용M형초성、이유초성（2DE）급실시삼유초성（RT3DE）대환유법락사련증（TOF）적영유인진행좌심수축공능평고급대비연구，탐토각방법대TOF환인위수술기좌심실수축공능평고적가행성급국한성，이기지도림상응용。방법선취재아원학진위TOF차년령소우4주세적환인102례（술전54례，술후2～3 d 48례），분별채용M형초성、2DE인도하적쌍평면Simpson법、RT3DE인도하적쌍평면Simp-son법이급RT3DE전용적중건법측량TOF환인좌심실사혈분수（LVEF），대비이상방법여RT3DE전용적중건법측치적일치성급각방법적중복성。결과2DE인도하적쌍평면Simpson법화RT3DE인도하적쌍평면Simpson법소측LVEF여RT3DE전용적중건법측치일치성교호（R치분별위0.38화0.96，P＜0.001），이M형초성측치여RT3DE전용적중건법무현저상관성（P＝0.11），진일보장병례분위술전급술후량조발현，술전M형초성측치여RT3DE전용적중건측치일치성교호（R＝0.37，P＝0.008），이술후M형측치여RT3DE전용적중건측치무현저상관성（P＝0.083）。상비전용적중건법，RT3DE인도하적쌍평면Simpson법저고좌심실서장말용적。 RT3DE소측좌심실서장말용적（ LVEDV）화LVEF，삼유인도하적Simpson법、이유인도하적Simpson법이급M형초성소측LVEF적관찰자내변이분별위（7±4）％，（6±3）％，（4±2）％，（10±7）％，（6±3）％；관찰자간변이분별위（15±6）％，（10±5）％，（7±5）％，（14±11）％，（11±4）％。결론 RT3DE인도하적쌍평면Simpson법급RT3DE전용적중건법대TOF위수술기좌심실공능평고구유교고적가행성，2DE인도하적쌍평면Simpson법차지；이M형초성총체평고효과교차，병주요체현재대TOF술후환인적심공능평고상。각측량방법중복성균재림상가접수범위내。
Objective To compare the utility of M mode (M-echo),2-dimensional(2DE),Real-time 3-dimensional ( RT3DE) echocardiographic techniques for quantitative assessment of perioperative left ventricular systolic function in neonates and infants with tetralogy of Follot ( TOF) and discuss their feasibility and imperfection of application in this particular group of patients .Methods 102 patients aged <4 years ( pre-operative:54;post-operative,two or three days after surgery:48)who were diagnosed as TOF in our hospital were enrolled ,to compare the feasibility and reproducibility in the left ventricular ejection fraction ( LVEF) measurement by M-echo,2D and RT3DE derived biplane Simpson′s method with RT3DE reconstruction method .Results The correlation and agreement between 2DE, RT3DE derived biplane Simpson′s method and RT3DE reconstruction method were significant(R=0.38 and 0.96 respectively,P<0.001)except for the M-echo′s measurement(P=0.11),further analysis by dividing the whole subjects into two groups with pre-and post-operative cases ,correlation between M-echo and RT3DE reconstruction were found to be significant in the pre-operative group ( R =0.37, P =0.008 ) and insignificant in the post-operative group ( P=0.083 ) .Compared with reconstruction method , the biplane Simpson′s method underestimated the end diastolic left ventricular volume .Intra-observer variabilities of the four techniques ( M-echo,2DE derived biplane Simpson,RT3DE derived Biplane Simpson and RT3DE reconstruction)were(7 ±4)%,(6 ±3)%,(4 ±2)%,(10 ±7)%and(6 ±3)% respectively and inter-observer variablities were (15 ±6)%,(10 ± 5)%,(7 ±5)%,(14 ±11)% and(11 ±4)% respectively.Conclusions RT3DE derived biplane Simpson′s method and reconstruction method are two feasible techniques in the perioperative left ventricular systolic functional assessment of TOF in neonates and infants , 2DE derived biplane Simpson′s method is inferior to be adopted comparatively , while M-echo performs worst , especially in the assessment of post-operative group of patients . Reproducibility of the four echocardiographic techniques is all acceptable in clinical application .