本文關(guān)鍵詞： 法洛氏四聯(lián)癥 實(shí)時(shí)三維超聲心動(dòng)圖 64排螺旋CT 右心功能指數(shù) McGoon指數(shù)　出處：《河北醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：法洛氏四聯(lián)癥（TOF）是先天性心臟病中較多見(jiàn)的右-左分流型紫紺型心臟病。室間隔缺損，右心室肥厚，肺動(dòng)脈高壓，主動(dòng)脈騎跨成為其主要的病理變化。超聲心動(dòng)圖可以對(duì)法洛氏四聯(lián)癥做出正確的診斷，使我們對(duì)疾病能夠得出形象的認(rèn)識(shí)。隨著醫(yī)療影像技術(shù)的不斷更新和應(yīng)用于臨床,實(shí)時(shí)三維超聲心動(dòng)圖（ＲＴ－３ＤＥ）的出現(xiàn)，為法洛氏四聯(lián)癥患者的治療提供了更為準(zhǔn)確的依據(jù)和憑證。其能夠即時(shí)的呈現(xiàn)心臟的具體形態(tài)和結(jié)構(gòu)，且可通過(guò)分割心臟的不同平面，對(duì)心臟不同角度的測(cè)量，完整的顯示心臟病變的位置，大��；病變周圍的毗鄰關(guān)系和立體形態(tài)。更加直觀的呈現(xiàn)出病變的范圍，使病變具體形象的呈現(xiàn)在我們面前。同時(shí)患者右心室功能的狀態(tài)與法洛氏四聯(lián)癥的手術(shù)方式和患者預(yù)后關(guān)系密切。法洛氏四聯(lián)癥患者術(shù)后的生活質(zhì)量和生存率直接受到了其右心功能的影響。因此右心功能的準(zhǔn)確評(píng)價(jià)對(duì)于臨床具有非常重要的現(xiàn)實(shí)意義，尤其是在對(duì)法洛氏四聯(lián)癥患者診斷和治療的過(guò)程中意義非凡。心肌功能指數(shù)，即Tei指數(shù)［1］，作為超聲心動(dòng)圖中的一個(gè)衡量指標(biāo)是即射血分?jǐn)?shù)之后又一個(gè)反應(yīng)心臟功能的數(shù)據(jù)。它是能夠具體的反映心臟收縮功能和舒張功能的良好指標(biāo)之一，使用超聲心動(dòng)圖測(cè)量右心功能指數(shù)，方便，快捷且對(duì)患者不會(huì)造成創(chuàng)傷，用其估測(cè)法洛氏四聯(lián)癥患者根治術(shù)前后的右心室功能狀態(tài)及其變化，以便指導(dǎo)臨床治療和觀察臨床預(yù)后。 目的： 1研究使用ＲＴ－３ＤＥ評(píng)估ＴＯＦ根治術(shù)前后患者右心結(jié)構(gòu)(右心室舒張末容積及右心室收縮末容積）和功能狀態(tài)（右心室射血分?jǐn)?shù)及右心肌功能指數(shù)）的意義。 2研究ＲＴ－３ＤＥ與核磁共振（ＭＲＩ）在對(duì)ＴＯＦ患者的右心結(jié)構(gòu)的測(cè)量和右心功能的測(cè)量方面的相關(guān)性,以便指導(dǎo)臨床手術(shù)治療。 3研究應(yīng)用心肌功能指數(shù)對(duì)法洛氏四聯(lián)癥患者右心功能評(píng)價(jià)的臨床指導(dǎo)意義。探究法洛氏四聯(lián)癥根治術(shù)中不同手術(shù)方式（即跨環(huán)補(bǔ)片修補(bǔ)和單純流出道補(bǔ)片修補(bǔ)）對(duì)患者右心肌功能指數(shù)的影響。 方法：收集我科2011年1月-2013年10月法洛氏四聯(lián)癥根治術(shù)后生存的，排除其他心臟畸形合并外科手術(shù)需要同步修復(fù)治療的心臟病患者，共30例。所有30例ＴＯＦ病人全部在心內(nèi)直視下行一期法洛氏四聯(lián)癥根治術(shù)，記錄手術(shù)所用的時(shí)間，心臟直視下心肺轉(zhuǎn)流時(shí)間，氣管插管及無(wú)創(chuàng)正壓通氣輔助時(shí)間，，重癥監(jiān)護(hù)室停留時(shí)間和術(shù)后極化液營(yíng)養(yǎng)心肌時(shí)間；所有行法洛氏四聯(lián)癥一期根治術(shù)患的者在術(shù)前行64排螺旋CT檢查和實(shí)時(shí)三維超聲心動(dòng)圖檢查。使用兩種方法分別測(cè)量右心室舒張末容量，收縮末容量，計(jì)算射血分?jǐn)?shù)；比較兩種檢查方式的相關(guān)性。術(shù)后3個(gè)月和6個(gè)月均測(cè)量手術(shù)后患者右心室心肌功能指數(shù)，同時(shí)應(yīng)用實(shí)時(shí)三維超聲心動(dòng)圖測(cè)量右心室舒張末容量，收縮末容量，推算右心室射血分?jǐn)?shù)。將術(shù)前和術(shù)后不同階段（術(shù)后3個(gè)月及術(shù)后6個(gè)月）所測(cè)量的數(shù)據(jù)進(jìn)行對(duì)比分析。測(cè)量所得數(shù)據(jù)均應(yīng)用均數(shù)±標(biāo)準(zhǔn)差（x±s）表示。應(yīng)用spss13.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析處理。 結(jié)果： 130例患者的比較手術(shù)時(shí)長(zhǎng)，體外循環(huán)機(jī)轉(zhuǎn)機(jī)時(shí)間，氣管插管及無(wú)創(chuàng)正壓通氣輔助時(shí)間，重癥監(jiān)護(hù)室停留時(shí)間和術(shù)后極化液營(yíng)養(yǎng)心肌時(shí)間差異均無(wú)統(tǒng)計(jì)學(xué)意義；手術(shù)時(shí)長(zhǎng)105±23.5min，體外循環(huán)轉(zhuǎn)機(jī)時(shí)間79.5±19.4min，氣管插管及無(wú)創(chuàng)正壓通氣輔助時(shí)間50.1±7.2h，重癥監(jiān)護(hù)室停留時(shí)間3.8±1.6d和術(shù)后極化液營(yíng)養(yǎng)心肌時(shí)間58.2±14.7min。 2共有7例患法洛氏四聯(lián)癥患者術(shù)前右心室收縮功能較差，EF值低于45%，在所有收集的30例患者中占例數(shù)的23.3%。在術(shù)后第3個(gè)月和術(shù)后第6個(gè)月，將所有行法洛氏四聯(lián)癥一期根治術(shù)的患者，進(jìn)行實(shí)時(shí)三維超聲心動(dòng)圖檢查，所測(cè)得的右心室收縮期和舒張期內(nèi)徑較術(shù)前均變小，右心室EF值較術(shù)前增加。法洛氏四聯(lián)癥患者實(shí)時(shí)三維超聲心動(dòng)圖所測(cè)右心室數(shù)據(jù)與64排螺旋CT三維重建所測(cè)得的RVEDV,RVESV及RVEF數(shù)值相關(guān)性良好；實(shí)時(shí)三維超聲心動(dòng)圖計(jì)算出的右心室射血分?jǐn)?shù)EF值與64排螺旋CT所測(cè)McGoon值呈線性相關(guān)。 3術(shù)后3個(gè)月和后6個(gè)月，與法洛氏四聯(lián)癥一期根治術(shù)前相比右心室TEI指數(shù)下降，差異有統(tǒng)計(jì)學(xué)意義（P0.05）。法洛氏四聯(lián)癥根治術(shù)后第6個(gè)月與和術(shù)后第3個(gè)月相比Tei指數(shù)明顯減小，差異有統(tǒng)計(jì)學(xué)意義。（P0.01） 430例法洛氏四聯(lián)癥患者中單純采用流出道補(bǔ)片修補(bǔ)的共7例,使用夸環(huán)修補(bǔ)的共23例，隨訪患者術(shù)后第3個(gè)月和術(shù)后第6個(gè)月心功能狀態(tài)，單純采用流出道修補(bǔ)的右心室等容舒張時(shí)間及等容收縮時(shí)間較夸環(huán)修補(bǔ)的縮短，TEI指數(shù)下降，兩者有統(tǒng)計(jì)學(xué)意義（P0.05） 結(jié)論： 1實(shí)時(shí)三維超聲心動(dòng)圖及其右心功能指數(shù)可以確切的評(píng)估法洛氏四聯(lián)癥患者的右心功能狀態(tài)。 2實(shí)時(shí)三維超聲心動(dòng)圖與MRI所測(cè)得的右心室數(shù)據(jù)相關(guān)性良好，右心功能指數(shù)和右心室射血分?jǐn)?shù)可間接映射出疾病對(duì)肺動(dòng)脈的作用影響。實(shí)時(shí)三維超聲心動(dòng)圖為T(mén)OF的治療提供明確的診斷依據(jù)。 3法洛氏四聯(lián)癥根治術(shù)后右心功能狀態(tài)和右心結(jié)構(gòu)均發(fā)生了明顯的變化，右心功能指數(shù)較術(shù)前變小。 4法洛氏四聯(lián)癥根治術(shù)中采用單純流出道修補(bǔ)的手術(shù)方式對(duì)右心功能影響較小，手術(shù)方式的不同對(duì)右心功能指數(shù)影響差異較明顯；
[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錛

本文編號(hào)：1554634