超声心动图定性与定量诊断房间隔缺损、室间隔缺损、动脉导管未闭在经导管封堵术的价值
发布时间：2018-08-15 12:22
【摘要】：[目的]评价二维超声心动图(Two-dimensional echocardiography,2-DE)定性与定量诊断房间隔缺损(Atrial septal defect,ASD)、室间隔缺损(Ventricular septal defect,VSD)、动脉导管未闭(Patent ductus arteriosus,PDA)在经导管缺损封堵术的价值。总结超声心动图测量ASD、VSD、PDA缺口的方法。[方法]选取2014年1月～2016年12月在昆明医科大学第一附属医院经TTE初步诊断为ASD患者523例,其中男174例,女349例,年龄1～71岁,平均年龄30.78±19.20岁。275例(52.6%)术前单纯由TTE筛选,248例(47.4%)术前由TTE和TEE共同筛选,所有患者术前TTE和(或)TEE的诊断与术后诊断对比,TTE、TEE测量ASDmax分别与封堵器腰径直径做相关性分析,建立线性回归方程。102例患者术前TTE对软边ASDmax、硬边ASDmax测量,TTE测量软边ASDmax、硬边ASDmax、TEE测量ASDmax分别与封堵器腰径直径做相关性分析,建立线性回归方程。选取2014年1月～2016年12月在昆明医科大学第一附属医院经TTE初步诊断为VSD的患者170例,其中男87例,女83例,年龄2～63岁,平均年龄15.76±15.80岁。所有病例对TTE的诊断与术后诊断对比。170例术前由TTE筛选的VSD患者,将术前行TTE测量VSD左室侧、右室侧、腰部缺口宽度分别与封堵器腰径做相关性分析,建立回归方程。选取2014年1月～2016年12月在昆明医科大学第一附属医院经TTE初步诊断为PDA的患者160例,其中男47例,女113例,年龄1～68岁,平均年龄15.44±15.03岁。所有病例对TTE的诊断与术后诊断对比。160例术前由TTE筛选的VSD患者,将TTE测量PDADao与封堵器主动脉侧直径及TTE测量PDADPa与封堵器肺动脉侧直径分别做相关分析,建立回归方程。[结果]1.术前单纯由TTE筛选ASD患者准确率(100%)与术前由TTE和TEE共同筛选的ASD患者的准确率(100%)无统计学差异(P0.05),TTE即可准确诊断ASD。TTE术前诊断单纯性VSD的准确率为100%。TTE术前诊断PDA的准确率为100%。2.TTE测量ASDmax与ASO腰径直径的关系:TTE测量ASDmax(14.0±6.5mm)与封堵器腰径(20.2±6.8mm)有统计学差异(P0.05),TTE测量ASDmax与ASO腰径之间具有相关性(r=0.7,P0.001),回归方程:Y= 9.835 + 0.737x(P0.05)。3.TTE和TEE测量ASDmax与ASO腰径直径关系:TTE、TEE测量ASDmax(17.1±7.2mm,19.6±8.1mm)分别与 ASO 腰径(25.8±7.3mm)之间存在统计学差异(P0.05),TTE和TEE测量ASDmax与ASO腰径均具有相关性(r=0.670,P0.001;r=0.716,P0.001),TEE 测量 ASDmax 与 ASO 之间相关性较好,回归方程:TTE 与 ASO 腰径:Y=14.176+0.681x(P0.05);TEE 与 ASO 腰径:Y=13.236+0.643x(P0.05)。4.TTE测量软边ASDmax、硬边ASDmax分别与ASO腰径关系:软边ASDmax(12.3±5.3mm)、硬边ASDmax(17.8±5.4mm)分别与ASO腰径(19.8±6.9mm)之间存在统计学差异(P0.05),TTE测量软边ASDmax、硬边ASDmax分别与ASO腰径之间均具有相关性(r=0.718,P0.001;r=0.723,P0.001),TTE测量硬边ASDmax与ASO之间相关性较好;回归方程:TTE测量软边 ASDmax 与 ASO 腰径:Y = 8.220 + 0.938x(P0.05),TTE 测量硬边ASDmax 与 ASO 腰径:Y = 3.454 + 0.921x(P0.05)。5.TTE测量软边ASDmax、硬边ASDmax、TEE测量ASDmax与ASO腰径关系:TTE 测量软边 ASDmax(18.2±7.4mm)、硬边 ASDmax(24.1±7.1mm)、TEE测量ASDmax(20.9±8.0mm)分别与ASO腰径(27.4±7.3mm)之间存在统计学差异(P0.05);TTE测量软边ASDmax、硬边ASDmax、TEE测量ASDmax分别与ASO腰径之间均具有相关性(r=0.790,P0.001;r=0.741,P0.001;r = 0.739,P0.001);TTE测量软边ASDmax与ASO之间相关性最好;回归方程:TTE 测量软边 ASDmax 与 ASO 直径:Y=13.253 + 0.775x(P0.05),TTE 测量硬边 ASDmax 与 ASO 直径:Y=8.936+0.765x(P0.05),TEE 测量ASDmax 与 ASO 直径:Y=13.245+0.674x(P0.05)。6.TTE测量VSD左室侧、右室侧、腰部缺口宽度与VSO腰径关系。VSO腰径(8.2±2.7mm)与TTE测量VSD左室侧缺口宽度(8.4±3.1mm)之间无统计学差异(P0.05),TTE测量右室侧(6.6±2.6mm)、腰部缺口宽度(6.3±2.0mm)与VSO腰径(8.2±2.7mm)之间存在统计学差异(P0.01);TTE测量VSD左室侧、右室侧、腰部缺口宽度分别与VSO腰径之间具有相关性(r=0.559,P0.001;r=0.481,P0.001;r=0.362,P0.001),TTE 测量 VSD 左室侧缺口宽度与VSO之间相关性大于TTE测量右室侧、腰部缺口宽度;回归方程:TTE测量 VSD 左室侧缺口宽度与 VSO 腰径:Y = 4.073 + 0.489x(P0.05);TTE测量 VSD 腰部缺口 宽度与 VSO 腰径:Y=4.085 + 0.657x(P0.05);TTE 测量 VSD 右室侧缺口宽度与 VSO 腰径:Y=5.705+0.376x(P0.05)。7.TTE测量PDADao与ADO主动脉侧的关系,及TTE测量PDADPa与ADO肺动脉侧之间的关系。TTE测量PDADao(8.5±3.9mm)与ADO主动脉侧(12.0±4.4mm)、TTE 测量 PDADPa(8.0±4.2mm)与 ADO 肺动脉侧(10.5±4.2mm)之间存在统计学差异(P0.01);TTE测量PDADao与ADO主动脉侧直径、TTE测量PDADPa与ADO肺动脉侧直径之间具有相关性(r=0.721,P0.001;r=0.653,P0.001),TTE测量PDADao与ADO主动脉侧直径相关性程度较高;回归方程:TTE测量PDADao与ADO主动脉侧:Y=5.159+0.809x(P0.05);TTE 测量 PDADPa 与 ADO 肺动脉侧:Y=5.255+0.656x(P0.05)。[结论]1.二维超声心动图能准确定性诊断房间隔缺损、室间隔缺损、动脉导管未闭。2.TTE、TEE测量ASDmax分别与ASO腰径均有相关性,但TEE测值指导选择封堵器腰径较,TTE更为可靠;TTE测量软边ASDmax、硬边ASDmax、TEE测量ASDmax分别与ASO腰径都具有相关性,TTE测量硬边ASDmax与ASO之间相关程度高,推荐在TTE测量ASDmax时,应对完全无支持力的极软边剔除。3.TTE测量VSD左室侧、右室侧、腰部缺口宽度分别与VSO腰径均有相关性,TTE测量VSD左室侧与VSO腰径的相关程度高,TTE测量VSD左室侧缺口宽度指导选择封堵器腰径较为可靠。4.TTE测量PDADao与ADO主动脉侧直径及TTE测量PDADPa与ADO肺动脉侧直径均有统计学差异和相关性,TTE测量PDADao与封堵器主动脉侧直径的相关性较高,建议依据PDADao指导封堵器腰径的选择。
[Abstract]:[Objective] To evaluate the value of two-dimensional echocardiography (2-DE) in qualitative and quantitative diagnosis of atrial septal defect (ASD), ventricular septal defect (VSD) and patent ductus arteriosus (PDA) in transcatheter closure of atrial septal defect (ASD). [Methods] 523 patients with ASD were selected from the First Affiliated Hospital of Kunming Medical University from January 2014 to December 2016, including 174 males and 349 females, aged 1-71 years, with an average age of 30.78 [19.20]. 275 patients (52.6%) were screened by TTE before operation alone, 248 (47.4%) were screened by TTE and TEE before operation. Preoperative and postoperative diagnosis of TTE and/or TEE were compared. Correlation analysis was made between ASDmax measured by TTE and TEE and waist diameter of occluder. Linear regression equation was established. Preoperative measurement of soft ASDmax, hard ASDmax by TTE, soft ASDmax by hard ASDmax by TEE and waist diameter by occluder in 102 patients. A linear regression equation was established. 170 patients with VSD diagnosed by TTE in the First Affiliated Hospital of Kunming Medical University from January 2014 to December 2016 were selected, including 87 males and 83 females, aged 2-63 years, with an average age of 15.76 (+ 15.80). Preoperative TTE measurements of left ventricular, right ventricular and lumbar notch widths were used to correlate with the lumbar diameter of the occluder, and regression equations were established. All patients were 3 years old. The diagnosis and postoperative diagnosis of TTE were compared. 160 patients with VSD were screened by TTE before operation. The correlation between PDADao and aortic diameter of occluder, PDADPa and pulmonary artery diameter of occluder were analyzed by TTE, and the regression equation was established. 1. The accuracy of screening ASD patients by TTE alone before operation (100%) was compared with that by T before operation. There was no significant difference in the accuracy of ASD screened by TE and TEE (P 0.05). TTE could accurately diagnose simple VSD preoperatively. The accuracy of PDA preoperatively was 100%. 2. The relationship between ASDmax and ASO waist diameter measured by TTE: ASDmax (14.0+6.5mm) measured by TTE and waist diameter of occluder (20.2+6.8mm) were statistically significant. There was a correlation between ASDmax measured by TTE and ASO waist diameter (r = 0.7, P 0.001). Regression equation: Y = 9.835 + 0.737x (P 0.05). 3. Relationship between ASDmax measured by TTE and ASO waist diameter measured by TEE: TTE, ASDmax measured by TEE (17.1 + 7.2 mm, 19.6 + 8.1 mm) and ASO waist diameter measured by ASDmax (25.8 + 7.3 mm) were statistically different (P 0.05). There was a good correlation between TEE and ASO waist diameters (r = 0.670, P 0.001; r = 0.716, P 0.001). The regression equation: TTE and ASO waist diameters: Y = 14.176 + 0.681x (P 0.05); TEE and ASO waist diameters: Y = 13.236 + 0.643x (P 0.05). 4. TTE measured soft ASDmax, hard ASDmax and ASO waist diameters: soft ASDmax (12.3 + 5.3mm), hard ASDmax respectively. There was significant difference between ASDmax and ASO waist diameter (P 0.05). Soft ASDmax and hard ASDmax were correlated with ASO waist diameter (r = 0.718, P 0.001, r = 0.723, P 0.001) by TTE, and ASO waist diameter was correlated with hard ASDmax by TTE. 8.220+0.938x (P 0.05), hard ASDmax and ASO waidiameters were measured by TTE: Y = 3.454+0.921x (P 0.05).There are statistics between them There was significant correlation between ASDmax measured by TTE, ASDmax measured by TEE and ASO waist diameter (r = 0.790, P 0.001; r = 0.741, P 0.001; r = 0.739, P 0.001); ASDmax measured by TTE had the best correlation with ASO; regression equation: ASDmax measured by TTE had the best correlation with ASO diameter: 13.253 + 0.775x measured by TTE (P 0.05). Side ASDmax and ASO diameters: Y = 8.936 + 0.765x (P 0.05), TEE measurement ASDmax and ASO diameters: Y = 13.245 + 0.674x (P 0.05). 6. TTE measurement VSD left ventricular side, right ventricular, lumbar notch width and VSO waist diameter. VSO waist diameter (8.2 + 2.7mm) and TTE measurement VSD left ventricular notch width (8.4 + 3.1mm) between no significant difference (P 0.05), TTE measurement VSD right ventricular notch width (6.6 + 3.1mm). There was significant difference between VSO waist diameter (P 0.01) and waist notch width (6.3+2.0 mm), TTE measurement of VSD left ventricular, right ventricular, waist notch width and VSO waist diameter (r = 0.559, P 0.001; r = 0.481, P 0.001; r = 0.362, P 0.001), TTE measurement of VSD left ventricular notch width and VSO were more correlated than TTE measurement of VSD waist diameter (r = 0.559, P 0.001). The left ventricular notch width and VSO waist diameter were measured by TTE (Y = 4.073 + 0.489x) (P 0.05); the waist notch width and VSO waist diameter were measured by TTE (Y = 4.085 + 0.657x) (P 0.05); the right ventricular notch width and VSO waist diameter were measured by TTE (Y = 5.705 + 0.376x) (P 0.05). The relationship between PDADPa and ADO pulmonary artery was measured by TTE. The diameter of PDADao and ADO pulmonary artery was measured by TTE. The diameter of PDADao and ADO pulmonary artery was measured by TTE. The diameter of PDADao and ADO pulmonary artery was measured by TTE. There was a correlation between diameters (r = 0.721, P 0.001; r = 0.653, P 0.001). The correlation between PDADao and ADO aortic diameter measured by TTE was high; Regression equation: TTE measured PDADao and ADO aortic side: Y = 5.159 + 0.809x (P 0.05); TTE measured PDADPa and ADO pulmonary artery side: Y = 5.255 + 0.656x (P 0.05). [Conclusion]1.2-D echocardiography can accurately diagnose the disease. ASDmax measured by TEE was more reliable than that by TTE in guiding the selection of occluder waist diameter. ASDmax measured by TTE in soft side, ASDmax measured by hard side, ASDmax measured by TEE were correlated with ASO waist diameter, and the correlation between ASDmax and ASO waist diameter measured by TTE in hard side. The width of the left ventricular, right ventricular and lumbar notches in VSD were correlated with the waist diameter of VSO respectively. The correlation between the left ventricular side of VSD measured by TTE and the waist diameter of VSO was high. The width of left ventricular notch measured by TTE was more reliable in choosing the waist diameter of occluder. There were significant differences and correlations between PDADao and ADO aortic side diameters and between PDADPa and ADO pulmonary side diameters measured by TTE. The correlation between PDADao and aortic side diameters measured by TTE was higher. It is suggested that the waist diameter of occluder should be selected according to PDADao.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R54
本文编号：2184185
[Abstract]:[Objective] To evaluate the value of two-dimensional echocardiography (2-DE) in qualitative and quantitative diagnosis of atrial septal defect (ASD), ventricular septal defect (VSD) and patent ductus arteriosus (PDA) in transcatheter closure of atrial septal defect (ASD). [Methods] 523 patients with ASD were selected from the First Affiliated Hospital of Kunming Medical University from January 2014 to December 2016, including 174 males and 349 females, aged 1-71 years, with an average age of 30.78 [19.20]. 275 patients (52.6%) were screened by TTE before operation alone, 248 (47.4%) were screened by TTE and TEE before operation. Preoperative and postoperative diagnosis of TTE and/or TEE were compared. Correlation analysis was made between ASDmax measured by TTE and TEE and waist diameter of occluder. Linear regression equation was established. Preoperative measurement of soft ASDmax, hard ASDmax by TTE, soft ASDmax by hard ASDmax by TEE and waist diameter by occluder in 102 patients. A linear regression equation was established. 170 patients with VSD diagnosed by TTE in the First Affiliated Hospital of Kunming Medical University from January 2014 to December 2016 were selected, including 87 males and 83 females, aged 2-63 years, with an average age of 15.76 (+ 15.80). Preoperative TTE measurements of left ventricular, right ventricular and lumbar notch widths were used to correlate with the lumbar diameter of the occluder, and regression equations were established. All patients were 3 years old. The diagnosis and postoperative diagnosis of TTE were compared. 160 patients with VSD were screened by TTE before operation. The correlation between PDADao and aortic diameter of occluder, PDADPa and pulmonary artery diameter of occluder were analyzed by TTE, and the regression equation was established. 1. The accuracy of screening ASD patients by TTE alone before operation (100%) was compared with that by T before operation. There was no significant difference in the accuracy of ASD screened by TE and TEE (P 0.05). TTE could accurately diagnose simple VSD preoperatively. The accuracy of PDA preoperatively was 100%. 2. The relationship between ASDmax and ASO waist diameter measured by TTE: ASDmax (14.0+6.5mm) measured by TTE and waist diameter of occluder (20.2+6.8mm) were statistically significant. There was a correlation between ASDmax measured by TTE and ASO waist diameter (r = 0.7, P 0.001). Regression equation: Y = 9.835 + 0.737x (P 0.05). 3. Relationship between ASDmax measured by TTE and ASO waist diameter measured by TEE: TTE, ASDmax measured by TEE (17.1 + 7.2 mm, 19.6 + 8.1 mm) and ASO waist diameter measured by ASDmax (25.8 + 7.3 mm) were statistically different (P 0.05). There was a good correlation between TEE and ASO waist diameters (r = 0.670, P 0.001; r = 0.716, P 0.001). The regression equation: TTE and ASO waist diameters: Y = 14.176 + 0.681x (P 0.05); TEE and ASO waist diameters: Y = 13.236 + 0.643x (P 0.05). 4. TTE measured soft ASDmax, hard ASDmax and ASO waist diameters: soft ASDmax (12.3 + 5.3mm), hard ASDmax respectively. There was significant difference between ASDmax and ASO waist diameter (P 0.05). Soft ASDmax and hard ASDmax were correlated with ASO waist diameter (r = 0.718, P 0.001, r = 0.723, P 0.001) by TTE, and ASO waist diameter was correlated with hard ASDmax by TTE. 8.220+0.938x (P 0.05), hard ASDmax and ASO waidiameters were measured by TTE: Y = 3.454+0.921x (P 0.05).There are statistics between them There was significant correlation between ASDmax measured by TTE, ASDmax measured by TEE and ASO waist diameter (r = 0.790, P 0.001; r = 0.741, P 0.001; r = 0.739, P 0.001); ASDmax measured by TTE had the best correlation with ASO; regression equation: ASDmax measured by TTE had the best correlation with ASO diameter: 13.253 + 0.775x measured by TTE (P 0.05). Side ASDmax and ASO diameters: Y = 8.936 + 0.765x (P 0.05), TEE measurement ASDmax and ASO diameters: Y = 13.245 + 0.674x (P 0.05). 6. TTE measurement VSD left ventricular side, right ventricular, lumbar notch width and VSO waist diameter. VSO waist diameter (8.2 + 2.7mm) and TTE measurement VSD left ventricular notch width (8.4 + 3.1mm) between no significant difference (P 0.05), TTE measurement VSD right ventricular notch width (6.6 + 3.1mm). There was significant difference between VSO waist diameter (P 0.01) and waist notch width (6.3+2.0 mm), TTE measurement of VSD left ventricular, right ventricular, waist notch width and VSO waist diameter (r = 0.559, P 0.001; r = 0.481, P 0.001; r = 0.362, P 0.001), TTE measurement of VSD left ventricular notch width and VSO were more correlated than TTE measurement of VSD waist diameter (r = 0.559, P 0.001). The left ventricular notch width and VSO waist diameter were measured by TTE (Y = 4.073 + 0.489x) (P 0.05); the waist notch width and VSO waist diameter were measured by TTE (Y = 4.085 + 0.657x) (P 0.05); the right ventricular notch width and VSO waist diameter were measured by TTE (Y = 5.705 + 0.376x) (P 0.05). The relationship between PDADPa and ADO pulmonary artery was measured by TTE. The diameter of PDADao and ADO pulmonary artery was measured by TTE. The diameter of PDADao and ADO pulmonary artery was measured by TTE. The diameter of PDADao and ADO pulmonary artery was measured by TTE. There was a correlation between diameters (r = 0.721, P 0.001; r = 0.653, P 0.001). The correlation between PDADao and ADO aortic diameter measured by TTE was high; Regression equation: TTE measured PDADao and ADO aortic side: Y = 5.159 + 0.809x (P 0.05); TTE measured PDADPa and ADO pulmonary artery side: Y = 5.255 + 0.656x (P 0.05). [Conclusion]1.2-D echocardiography can accurately diagnose the disease. ASDmax measured by TEE was more reliable than that by TTE in guiding the selection of occluder waist diameter. ASDmax measured by TTE in soft side, ASDmax measured by hard side, ASDmax measured by TEE were correlated with ASO waist diameter, and the correlation between ASDmax and ASO waist diameter measured by TTE in hard side. The width of the left ventricular, right ventricular and lumbar notches in VSD were correlated with the waist diameter of VSO respectively. The correlation between the left ventricular side of VSD measured by TTE and the waist diameter of VSO was high. The width of left ventricular notch measured by TTE was more reliable in choosing the waist diameter of occluder. There were significant differences and correlations between PDADao and ADO aortic side diameters and between PDADPa and ADO pulmonary side diameters measured by TTE. The correlation between PDADao and aortic side diameters measured by TTE was higher. It is suggested that the waist diameter of occluder should be selected according to PDADao.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R54
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4 沈艳;超声心动图在先天性心脏病房间隔缺损封堵术中的临床应用研究[D];昆明医学院;2008年
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