经食管三维超声心动图对感染性心内膜炎赘生物的诊断价值

发布时间：2018-05-19 21:05

本文选题：感染性心内膜炎 + 赘生物　；参考：《中华医院感染学杂志》2017年17期

【摘要】：目的探究经食管三维超声心动图(3D-TEE)对于感染性心内膜炎赘生物的诊断价值,为更好地治疗感染性心内膜炎提供依据。方法选取2015年10月-2016年12月于医院接受心脏手术的41例感染性心内膜炎患者为研究对象;所有患者术前行经胸超声心动图(TTE)和经食管三维超声心动图检查,重点观察心脏瓣膜及心腔是否存在赘生物、瓣膜关闭不全,有无瓣叶穿孔、瓣周脓肿;以外科手术病理为金标准,比较经食管三维超声心动图和经胸超声心动图检出赘生物的准确率、灵敏性、特异度、阳性预测值和阴性预测值;并比较两种方法对瓣叶穿孔、瓣周脓肿的检出准确率。结果 41例患者经食管三维超声心动图诊断赘生物32例,经外科手术证实为感染性心内膜炎赘生物30例,29例附着于心脏各瓣膜,呈大小不等、边缘毛糙的结节状或团絮状回声,受累瓣膜均伴不同程度的关闭不全;经食管三维超声心动图对感染性心内膜炎赘生物的检出准确率、灵敏性、特异度、阳性预测值和阴性预测值分别为92.68%、93.75%、88.89%、96.77%和80.00%,均高于经胸超声心动图,差异有统计学意义(P0.05);经食管三维超声心动图诊断瓣叶穿孔15例、瓣周脓肿12例,检出准确率分别为86.67%、84.61%,高于经胸超声心动图,差异有统计学意义(P0.05)。结论经食管三维超声心动图能清晰显示感染性心内膜炎赘生物的形态特征、附着部位,准确判断有无瓣叶穿孔、瓣周脓肿等并发症,具有重要的临床应用价值。
[Abstract]:Objective to explore the diagnostic value of transesophageal three-dimensional echocardiography (3D-TEE) in the treatment of infectious endocarditis and provide evidence for better treatment of infective endocarditis. Methods from October 2015 to December 2016, 41 patients with infective endocarditis underwent cardiac surgery in hospital. All patients underwent transthoracic echocardiography (TTE) and transesophageal three-dimensional echocardiography (TTE) before operation. It is important to observe whether there are vegetations in the heart valve and heart cavity, whether the valve is not closed or not, whether or not there is perforation of the valve lobe, and whether there is a perivalvular abscess. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of neoplasm were compared between transesophageal three-dimensional echocardiography and transthoracic echocardiography, and the accuracy of the two methods in detecting valve lobe perforation and perivalvular abscess was compared. Results Thirty-two cases of neoplasm were diagnosed by transesophageal three-dimensional echocardiography, and 30 cases were confirmed by surgery as infective endocarditis. 29 cases were attached to the heart valves, showing nodular or flocculent echo with different sizes and rough edges. The accuracy, sensitivity and specificity of transesophageal three-dimensional echocardiography in detecting neoplasm in infective endocarditis were observed. The positive predictive value and negative predictive value were 92.68 and 93.758.89, respectively, which were higher than that of transthoracic echocardiography (P 0.05), 15 cases of perforation of valve lobe and 12 cases of perivalvular abscess were diagnosed by transesophageal three-dimensional echocardiography. The accuracy of detection was 86.67 and 84.61, which was higher than that of transthoracic echocardiography (P 0.05). Conclusion Three-dimensional transesophageal echocardiography can clearly display the morphological features and attachment site of neoplasm in infective endocarditis, and can accurately judge the complications such as perforation of valve lobe and perivalvular abscess, which has important clinical application value.
【作者单位】：南华大学附属第一医院超声科;
【基金】：湖南省卫生计生委基金资助项目(B2015-53)
【分类号】：R540.45;R542.4

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