【摘要】：目的： 探討超聲心動(dòng)圖對(duì)室間隔完整型完全性大動(dòng)脈轉(zhuǎn)位動(dòng)脈調(diào)轉(zhuǎn)手術(shù)預(yù)后的判斷作用。 方法： 收集我院2007年1月至2011年12月經(jīng)超聲診斷后行動(dòng)脈調(diào)轉(zhuǎn)手術(shù)治療室間隔完整型完全性大動(dòng)脈轉(zhuǎn)位的49例患兒為研究對(duì)象。通過超聲心動(dòng)圖診斷患兒的心臟解剖情況,測量并記錄心功能指標(biāo),包括左心室舒張期內(nèi)徑,左心室后壁舒張期內(nèi)徑,舒張期室間隔厚度,左心室射血分?jǐn)?shù),左心室縮短分?jǐn)?shù)等。根據(jù)公式計(jì)算左心質(zhì)量指數(shù)。記錄患兒的手術(shù)情況和術(shù)后轉(zhuǎn)歸。分別分析患兒超聲心動(dòng)圖的特征和動(dòng)脈調(diào)轉(zhuǎn)術(shù)結(jié)果的變化。 結(jié)果： 49例患兒中,術(shù)中或術(shù)后早期死亡4例,其余均治愈出院,手術(shù)成功率為91.84%。與手術(shù)診斷結(jié)果比較,超聲心動(dòng)圖診斷室間隔完整型完全性大動(dòng)脈轉(zhuǎn)位的準(zhǔn)確率為100%,對(duì)合并解剖畸形診斷的準(zhǔn)確率為91.84%。室間隔完整型完全性大血管轉(zhuǎn)位的患兒,其左心室射血分?jǐn)?shù)和左心室縮短分?jǐn)?shù)隨年齡逐漸下降(P0.05),死亡組的左心室射血分?jǐn)?shù)、左心室質(zhì)量指數(shù)低于存活組。手術(shù)風(fēng)險(xiǎn)增加與患兒左心室射血分?jǐn)?shù)下降(P0.05),左心室縮短分?jǐn)?shù)下降(P0.05),左心室質(zhì)量指數(shù)偏低(P0.01),存在室間隔左偏(P0.05),合并冠狀動(dòng)脈異常(P0.05)有關(guān)。PDA直徑偏細(xì)(P0.05),左心室縮短分?jǐn)?shù)下降(P0.05),左心室質(zhì)量指數(shù)偏低(P0.05),冠狀動(dòng)脈異常(P0.01)時(shí),患兒術(shù)后住院時(shí)間延長。 結(jié)論： 超聲心動(dòng)圖能比較準(zhǔn)確的診斷完全性大動(dòng)脈轉(zhuǎn)位及心內(nèi)合并畸形。患兒術(shù)前的左心室功能狀態(tài)與術(shù)后轉(zhuǎn)歸有一定的相關(guān)性,而術(shù)前超聲診斷能準(zhǔn)確評(píng)估患兒左心室功能,超聲心動(dòng)圖對(duì)室間隔完整型完全性大動(dòng)脈轉(zhuǎn)位動(dòng)脈調(diào)轉(zhuǎn)術(shù)的手術(shù)預(yù)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(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R726.5

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本文編號(hào)：2505956