实时三维超声心动图对法洛氏四联症患者手术前后右心室功能分析

发布时间：2018-03-02 02:25

  本文关键词： 法洛氏四联症 实时三维超声心动图 64排螺旋CT 右心功能指数 McGoon指数　出处：《河北医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：法洛氏四联症（TOF）是先天性心脏病中较多见的右-左分流型紫绀型心脏病。室间隔缺损，右心室肥厚，肺动脉高压，主动脉骑跨成为其主要的病理变化。超声心动图可以对法洛氏四联症做出正确的诊断，使我们对疾病能够得出形象的认识。随着医疗影像技术的不断更新和应用于临床,实时三维超声心动图（ＲＴ－３ＤＥ）的出现，为法洛氏四联症患者的治疗提供了更为准确的依据和凭证。其能够即时的呈现心脏的具体形态和结构，且可通过分割心脏的不同平面，对心脏不同角度的测量，完整的显示心脏病变的位置，大小；病变周围的毗邻关系和立体形态。更加直观的呈现出病变的范围，使病变具体形象的呈现在我们面前。同时患者右心室功能的状态与法洛氏四联症的手术方式和患者预后关系密切。法洛氏四联症患者术后的生活质量和生存率直接受到了其右心功能的影响。因此右心功能的准确评价对于临床具有非常重要的现实意义，尤其是在对法洛氏四联症患者诊断和治疗的过程中意义非凡。心肌功能指数，即Tei指数［1］，作为超声心动图中的一个衡量指标是即射血分数之后又一个反应心脏功能的数据。它是能够具体的反映心脏收缩功能和舒张功能的良好指标之一，使用超声心动图测量右心功能指数，方便，快捷且对患者不会造成创伤，用其估测法洛氏四联症患者根治术前后的右心室功能状态及其变化，以便指导临床治疗和观察临床预后。 目的： 1研究使用ＲＴ－３ＤＥ评估ＴＯＦ根治术前后患者右心结构(右心室舒张末容积及右心室收缩末容积）和功能状态（右心室射血分数及右心肌功能指数）的意义。 2研究ＲＴ－３ＤＥ与核磁共振（ＭＲＩ）在对ＴＯＦ患者的右心结构的测量和右心功能的测量方面的相关性,以便指导临床手术治疗。 3研究应用心肌功能指数对法洛氏四联症患者右心功能评价的临床指导意义。探究法洛氏四联症根治术中不同手术方式（即跨环补片修补和单纯流出道补片修补）对患者右心肌功能指数的影响。 方法：收集我科2011年1月-2013年10月法洛氏四联症根治术后生存的，排除其他心脏畸形合并外科手术需要同步修复治疗的心脏病患者，共30例。所有30例ＴＯＦ病人全部在心内直视下行一期法洛氏四联症根治术，记录手术所用的时间，心脏直视下心肺转流时间，气管插管及无创正压通气辅助时间，，重症监护室停留时间和术后极化液营养心肌时间；所有行法洛氏四联症一期根治术患的者在术前行64排螺旋CT检查和实时三维超声心动图检查。使用两种方法分别测量右心室舒张末容量，收缩末容量，计算射血分数；比较两种检查方式的相关性。术后3个月和6个月均测量手术后患者右心室心肌功能指数，同时应用实时三维超声心动图测量右心室舒张末容量，收缩末容量，推算右心室射血分数。将术前和术后不同阶段（术后3个月及术后6个月）所测量的数据进行对比分析。测量所得数据均应用均数±标准差（x±s）表示。应用spss13.0软件进行统计学分析处理。 结果： 130例患者的比较手术时长，体外循环机转机时间，气管插管及无创正压通气辅助时间，重症监护室停留时间和术后极化液营养心肌时间差异均无统计学意义；手术时长105±23.5min，体外循环转机时间79.5±19.4min，气管插管及无创正压通气辅助时间50.1±7.2h，重症监护室停留时间3.8±1.6d和术后极化液营养心肌时间58.2±14.7min。 2共有7例患法洛氏四联症患者术前右心室收缩功能较差，EF值低于45%，在所有收集的30例患者中占例数的23.3%。在术后第3个月和术后第6个月，将所有行法洛氏四联症一期根治术的患者，进行实时三维超声心动图检查，所测得的右心室收缩期和舒张期内径较术前均变小，右心室EF值较术前增加。法洛氏四联症患者实时三维超声心动图所测右心室数据与64排螺旋CT三维重建所测得的RVEDV,RVESV及RVEF数值相关性良好；实时三维超声心动图计算出的右心室射血分数EF值与64排螺旋CT所测McGoon值呈线性相关。 3术后3个月和后6个月，与法洛氏四联症一期根治术前相比右心室TEI指数下降，差异有统计学意义（P0.05）。法洛氏四联症根治术后第6个月与和术后第3个月相比Tei指数明显减小，差异有统计学意义。（P0.01） 430例法洛氏四联症患者中单纯采用流出道补片修补的共7例,使用夸环修补的共23例，随访患者术后第3个月和术后第6个月心功能状态，单纯采用流出道修补的右心室等容舒张时间及等容收缩时间较夸环修补的缩短，TEI指数下降，两者有统计学意义（P0.05） 结论： 1实时三维超声心动图及其右心功能指数可以确切的评估法洛氏四联症患者的右心功能状态。 2实时三维超声心动图与MRI所测得的右心室数据相关性良好，右心功能指数和右心室射血分数可间接映射出疾病对肺动脉的作用影响。实时三维超声心动图为TOF的治疗提供明确的诊断依据。 3法洛氏四联症根治术后右心功能状态和右心结构均发生了明显的变化，右心功能指数较术前变小。 4法洛氏四联症根治术中采用单纯流出道修补的手术方式对右心功能影响较小，手术方式的不同对右心功能指数影响差异较明显；
[Abstract]:Tetralogy of Fallot (TOF) is the most common congenital heart disease in right left shunt congenital heart disease. Ventricular septal defect, right ventricular hypertrophy, pulmonary hypertension, aorta became the main pathological change. Echocardiography can make the correct diagnosis of tetralogy of Fallot, so we know to draw the image of the disease. With the updating of medical imaging technology and clinical application of real-time three-dimensional echocardiography (RT3DE) appears, for the treatment of patients with tetralogy of Fallot provide a more accurate basis and vouchers. It can show the specific shape and structure of the heart immediately, and through different planar segmentation of the heart, to measure the different angles of the heart, the complete display of cardiac lesion location, size; relationship and three-dimensional shape of the lesion. The more intuitive showing the extent of the lesion, the In the specific image in front of us. At the same time the relationship between state and tetralogy of Fallot surgery with right ventricular function and prognosis closely. In patients with tetralogy of Fallot after the survival and quality of life is directly affected by the impact of the right ventricular function. Therefore the accurate evaluation of right ventricular function has practical significance very important in the clinic, especially in the process of tetralogy of Fallot in diagnosis and treatment of patients with extraordinary significance. Cardiac function index, Tei index is 1, as a measure of echocardiography in the plot is that ejection fraction after a heart function data. It is one of the a good indicator to reflect the specific cardiac systolic function and diastolic function of right ventricular function, echocardiography measurement index, the use of ultrasound is convenient, fast and will not cause trauma to patients, with the estimation of tetralogy of Fallot patients In order to guide the clinical treatment and observe the clinical prognosis, the right ventricular function state and its changes before and after radical operation are given.
Objective:
1, we used RT 3DE to evaluate the significance of right ventricular structure (right ventricular end diastolic volume and right ventricular end systolic volume) and functional status (right ventricular ejection fraction and right ventricular function index) before and after TOF radical operation.
2, we studied the correlation between RT 3DE and magnetic resonance imaging (MRI) in the measurement of right ventricular structure and the measurement of right ventricular function in TOF patients, so as to guide clinical operation.
3, we studied the clinical significance of myocardial function index in the evaluation of right heart function in patients with tetralogy of Fallot. We explored the effect of different operative methods (i.e. cross ring patch repair and outflow tract patch repair) on right ventricular function index during the operation of tetralogy of Fallot.
Methods: from January 2011 October -2013 year survival after radical surgery of tetralogy of Fallot, other heart malformation with surgery need to synchronize repair in treatment of patients with heart disease were excluded in 30 cases. All 30 cases of TOF patients in open heart radical surgery of tetralogy of Fallot underwent one stage, the record of operation time, open heart surgery under cardiopulmonary bypass time, tracheal intubation and noninvasive positive pressure ventilation time, ICU stay time and postoperative nutrition myocardial polarization time; all underwent tetralogy of Fallot surgery in patients who underwent 64 slice spiral CT examination and real-time three-dimensional echocardiography. Two methods of using measured right ventricular end diastolic volume and end systolic volume and ejection fraction was calculated; the correlation between two kinds of examination methods. After 3 months and 6 months were measured in patients with right ventricular heart surgery Muscle function index, and the application of real-time three-dimensional echocardiography right ventricular end diastolic volume, end diastolic volume, right ventricular ejection fraction calculation. The preoperative and postoperative stage (after 3 months and 6 months after operation) the measured data were analyzed. The measured data were the application of standard deviation (x + s). SPSS13.0 software was used for statistical analysis.
Result锛

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