超声心动图对室间隔完整型完全性大动脉转位动脉调转术预后判断的临床研究

发布时间：2019-06-25 19:49

【摘要】：目的：探讨超声心动图对室间隔完整型完全性大动脉转位动脉调转手术预后的判断作用。方法：收集我院2007年1月至2011年12月经超声诊断后行动脉调转手术治疗室间隔完整型完全性大动脉转位的49例患儿为研究对象。通过超声心动图诊断患儿的心脏解剖情况,测量并记录心功能指标,包括左心室舒张期内径,左心室后壁舒张期内径,舒张期室间隔厚度,左心室射血分数,左心室缩短分数等。根据公式计算左心质量指数。记录患儿的手术情况和术后转归。分别分析患儿超声心动图的特征和动脉调转术结果的变化。结果： 49例患儿中,术中或术后早期死亡4例,其余均治愈出院,手术成功率为91.84%。与手术诊断结果比较,超声心动图诊断室间隔完整型完全性大动脉转位的准确率为100%,对合并解剖畸形诊断的准确率为91.84%。室间隔完整型完全性大血管转位的患儿,其左心室射血分数和左心室缩短分数随年龄逐渐下降(P0.05),死亡组的左心室射血分数、左心室质量指数低于存活组。手术风险增加与患儿左心室射血分数下降(P0.05),左心室缩短分数下降(P0.05),左心室质量指数偏低(P0.01),存在室间隔左偏(P0.05),合并冠状动脉异常(P0.05)有关。PDA直径偏细(P0.05),左心室缩短分数下降(P0.05),左心室质量指数偏低(P0.05),冠状动脉异常(P0.01)时,患儿术后住院时间延长。结论：超声心动图能比较准确的诊断完全性大动脉转位及心内合并畸形。患儿术前的左心室功能状态与术后转归有一定的相关性,而术前超声诊断能准确评估患儿左心室功能,超声心动图对室间隔完整型完全性大动脉转位动脉调转术的手术预后有较好的判断作用。
[Abstract]:Objective: to investigate the effect of echocardiography on the prognosis of complete transposition of great arteries with intact interventricular septum. Methods: from January 2007 to December 2011, 49 children with complete transposition of great arteries with intact interventricular septum were enrolled in this study. The cardiac anatomy of children was diagnosed by echocardiography. Cardiac function indexes, including left ventricular diastolic diameter, left ventricular posterior wall diastolic diameter, diastolic interventricular septum thickness, left ventricular ejection fraction and left ventricular shortening fraction, were measured and recorded. The mass index of left heart is calculated according to the formula. The operation and postoperative outcome of the children were recorded. The characteristics of echocardiography and the changes of arterial transposition were analyzed. Results: among 49 cases, 4 cases died during or after operation, the rest were cured and discharged from hospital, the success rate of operation was 91.84%. Compared with the results of surgical diagnosis, the accuracy of echocardiography in the diagnosis of complete transposition of great arteries with intact interventricular septum was 100%, and the accuracy of diagnosis of anatomic malformations was 91.84%. The left ventricular ejection fraction and left ventricular shortening fraction decreased gradually with age in children with complete macrovascular transposition with intact interventricular septum (P 0.05). The left ventricular ejection fraction and left ventricular mass index in the death group were lower than those in the survival group. The increased risk of operation was related to the decrease of left ventricular ejection fraction (P05), the decrease of left ventricular shortening fraction (P05), the low left ventricular mass index (P01), the left interventricular septum (P05), the abnormal coronary artery (P05). The diameter of PDA was smaller (P 0.05), the left ventricular shortening fraction (P05) was decreased, and the left ventricular mass index (LVMI) was lower (P05). When coronary artery was abnormal (P 0.01), the postoperative hospital stay was prolonged. Conclusion: echocardiography can accurately diagnose complete transposition of great arteries and intracardiac malformation. There is a certain correlation between the preoperative left ventricular function and the postoperative outcome, and the preoperative diagnosis can accurately evaluate the left ventricular function. Echocardiography plays a good role in judging the surgical prognosis of complete transposition of great arteries with intact interventricular septum.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R726.5

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