中华临床医师杂志(电子版)
中華臨床醫師雜誌(電子版)
중화림상의사잡지(전자판)
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
13期
5861-5865
,共5页
孙思娟%陈国珍%吴兰平%张玉奇
孫思娟%陳國珍%吳蘭平%張玉奇
손사연%진국진%오란평%장옥기
法洛四联症%超声心动描记术,三维%手术期间%心室功能,左%室间隔矛盾运动
法洛四聯癥%超聲心動描記術,三維%手術期間%心室功能,左%室間隔矛盾運動
법락사련증%초성심동묘기술,삼유%수술기간%심실공능,좌%실간격모순운동
Tetralogy of Fallot%Echocardiography,three-dimensional%Intraoperative period%Ventricular function,left%Paradoxical interventricular septal motion
目的:探讨法洛四联症(TOF)根治术后近期室间隔矛盾运动(PSM)的发生率及对术前后左心容积变化及收缩功能的影响并结合临床资料分析此类患者PSM产生的可能原因。方法采用实时三维超声( RT3DE)定量评估47例TOF患儿术前及术后2~3 d左心室舒张末容积指数( LVEDVI)、左心室收缩末容积指数(LVESVI)及左心室射血分数(LVEF)等指标,并根据三维全容积图像切割后的心尖四腔切面和短轴切面对PSM进行定性评估,对比分析合并PSM组和非合并PSM组患儿手术前后容积变化情况及术后左心收缩功能,结合手术因素、右心室相关病变及传导束病变等临床资料探讨 PSM 产生的可能原因。结果对比术前情况,术后2~3 d 47例TOF患儿LVEDVI无显著性变化( P=0.694), LVESVI有所增加( P<0.001),而LVEF显著下降( P<0.001);进一步研究发现,25例患儿术后LVEDVI增大,而22例患儿术后LVEDVI减小,同时47例TOF患儿中有21例合并PSM(44.7%),Pearson卡方检验显示PSM的存在与患儿术后LVEDVI减小密切相关(χ2=20.34,P<0.001)。合并PSM的患儿术后2~3 d LVEF测值相比非合并者低( P=0.021);TOF根治术后近期患儿PSM的产生与升主动脉阻断时间的长短( P=0.753)及术后合并左、右束支传导阻滞的相关性并不大,Pearson卡方检验显示合并PSM患儿同时伴右心室流出道梗阻的概率更大(χ2=4.309,P=0.038)。结论 TOF患儿术后近期室间隔矛盾运动的发生率较高(44.7%)并显著影响患儿术后左心容积变化及左心室收缩功能,此异常运动的产生一定程度上与右心室流出道梗阻相关。
目的:探討法洛四聯癥(TOF)根治術後近期室間隔矛盾運動(PSM)的髮生率及對術前後左心容積變化及收縮功能的影響併結閤臨床資料分析此類患者PSM產生的可能原因。方法採用實時三維超聲( RT3DE)定量評估47例TOF患兒術前及術後2~3 d左心室舒張末容積指數( LVEDVI)、左心室收縮末容積指數(LVESVI)及左心室射血分數(LVEF)等指標,併根據三維全容積圖像切割後的心尖四腔切麵和短軸切麵對PSM進行定性評估,對比分析閤併PSM組和非閤併PSM組患兒手術前後容積變化情況及術後左心收縮功能,結閤手術因素、右心室相關病變及傳導束病變等臨床資料探討 PSM 產生的可能原因。結果對比術前情況,術後2~3 d 47例TOF患兒LVEDVI無顯著性變化( P=0.694), LVESVI有所增加( P<0.001),而LVEF顯著下降( P<0.001);進一步研究髮現,25例患兒術後LVEDVI增大,而22例患兒術後LVEDVI減小,同時47例TOF患兒中有21例閤併PSM(44.7%),Pearson卡方檢驗顯示PSM的存在與患兒術後LVEDVI減小密切相關(χ2=20.34,P<0.001)。閤併PSM的患兒術後2~3 d LVEF測值相比非閤併者低( P=0.021);TOF根治術後近期患兒PSM的產生與升主動脈阻斷時間的長短( P=0.753)及術後閤併左、右束支傳導阻滯的相關性併不大,Pearson卡方檢驗顯示閤併PSM患兒同時伴右心室流齣道梗阻的概率更大(χ2=4.309,P=0.038)。結論 TOF患兒術後近期室間隔矛盾運動的髮生率較高(44.7%)併顯著影響患兒術後左心容積變化及左心室收縮功能,此異常運動的產生一定程度上與右心室流齣道梗阻相關。
목적:탐토법락사련증(TOF)근치술후근기실간격모순운동(PSM)적발생솔급대술전후좌심용적변화급수축공능적영향병결합림상자료분석차류환자PSM산생적가능원인。방법채용실시삼유초성( RT3DE)정량평고47례TOF환인술전급술후2~3 d좌심실서장말용적지수( LVEDVI)、좌심실수축말용적지수(LVESVI)급좌심실사혈분수(LVEF)등지표,병근거삼유전용적도상절할후적심첨사강절면화단축절면대PSM진행정성평고,대비분석합병PSM조화비합병PSM조환인수술전후용적변화정황급술후좌심수축공능,결합수술인소、우심실상관병변급전도속병변등림상자료탐토 PSM 산생적가능원인。결과대비술전정황,술후2~3 d 47례TOF환인LVEDVI무현저성변화( P=0.694), LVESVI유소증가( P<0.001),이LVEF현저하강( P<0.001);진일보연구발현,25례환인술후LVEDVI증대,이22례환인술후LVEDVI감소,동시47례TOF환인중유21례합병PSM(44.7%),Pearson잡방검험현시PSM적존재여환인술후LVEDVI감소밀절상관(χ2=20.34,P<0.001)。합병PSM적환인술후2~3 d LVEF측치상비비합병자저( P=0.021);TOF근치술후근기환인PSM적산생여승주동맥조단시간적장단( P=0.753)급술후합병좌、우속지전도조체적상관성병불대,Pearson잡방검험현시합병PSM환인동시반우심실류출도경조적개솔경대(χ2=4.309,P=0.038)。결론 TOF환인술후근기실간격모순운동적발생솔교고(44.7%)병현저영향환인술후좌심용적변화급좌심실수축공능,차이상운동적산생일정정도상여우심실류출도경조상관。
Objective To qualitatively analyze the paradoxical interventricular septal motion ( PSM ) and clarify its occurrence ,potential causes and impacts on the left ventricular volume and functional change in pediatric patients with tetralogy of Fallot after total correction surgery .Methods Transthoracic RT3DE database were acquired ( Philips 7500 ,X4 transducer ,frequency 2-4 MHz) in 47 pediatric patients with tetralogy of Fallot before and two or three days after total correction surgery,images were analyzed using prototype software (QLAB 3DQ advance).The occurrence of PSM was qualitatively evaluated in postoperative data ,changes of LV volume and function before and after surgery were also calculated by volume reconstruction method .Pearson′s Chi-squared test as well as the paired t test was adopted to clarify the impact of PSM on left ventricular volume change and postoperative LVEF . Furthermore,potential causes related to the occurrence of PSM (surgical factors,right ventricle related lesions and postoperative complications such as left and right bundle branch block etc .) were discussed combined with clinical data in those patients .Results Compared with preoperative measurements , left ventricular diastolic volume index (LVEDVI)was not obviously changed(P=0.694),while the end systolic volume index (LVESVI)increased(P<0.001)and left ventricular ejection fraction(LVEF)reduced(P<0.001)significantly two or three days after the total correction surgery.Further analysis showed that among the 47 cases,LVEDVI increased in 25 cases while decreased in 22 cases,at the same time,high incidence of PSM (44.7%,21/47) was found in those patients postoperatively which was closely correlated with the LVEDVI reduction (χ2 =20.34,P<0.001).LVEF in PSM patients was also significantly lower than those without PSM (P=0.021).Surgical factors such as aortic cross-clamp time(P=0.753) and postoperative left and right bundle branch block didn′t show any significant correlation with the occurrence of PSM,while right ventricular outflow tract obstruction (χ2 =4.309,P=0.038) were more obvious in patients with PSM.Conclusion Paradoxical interventricular septal motion is a common phenomenon in postoperative pediatric patients with tetralogy of Fallot and has an adverse impact on the left ventricular systolic function .Right ventricular outflow tract obstruction might be one of the potential causes of PSM in this group of patients .