【摘要】：目的： 探討超聲心動圖對室間隔完整型完全性大動脈轉位動脈調轉手術預后的判斷作用。 方法： 收集我院2007年1月至2011年12月經超聲診斷后行動脈調轉手術治療室間隔完整型完全性大動脈轉位的49例患兒為研究對象。通過超聲心動圖診斷患兒的心臟解剖情況,測量并記錄心功能指標,包括左心室舒張期內徑,左心室后壁舒張期內徑,舒張期室間隔厚度,左心室射血分數(shù),左心室縮短分數(shù)等。根據(jù)公式計算左心質量指數(shù)。記錄患兒的手術情況和術后轉歸。分別分析患兒超聲心動圖的特征和動脈調轉術結果的變化。 結果： 49例患兒中,術中或術后早期死亡4例,其余均治愈出院,手術成功率為91.84%。與手術診斷結果比較,超聲心動圖診斷室間隔完整型完全性大動脈轉位的準確率為100%,對合并解剖畸形診斷的準確率為91.84%。室間隔完整型完全性大血管轉位的患兒,其左心室射血分數(shù)和左心室縮短分數(shù)隨年齡逐漸下降(P0.05),死亡組的左心室射血分數(shù)、左心室質量指數(shù)低于存活組。手術風險增加與患兒左心室射血分數(shù)下降(P0.05),左心室縮短分數(shù)下降(P0.05),左心室質量指數(shù)偏低(P0.01),存在室間隔左偏(P0.05),合并冠狀動脈異常(P0.05)有關。PDA直徑偏細(P0.05),左心室縮短分數(shù)下降(P0.05),左心室質量指數(shù)偏低(P0.05),冠狀動脈異常(P0.01)時,患兒術后住院時間延長。 結論： 超聲心動圖能比較準確的診斷完全性大動脈轉位及心內合并畸形。患兒術前的左心室功能狀態(tài)與術后轉歸有一定的相關性,而術前超聲診斷能準確評估患兒左心室功能,超聲心動圖對室間隔完整型完全性大動脈轉位動脈調轉術的手術預后有較好的判斷作用。
[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.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R726.5

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