發(fā)布時間：2018-03-02 02:25

  本文關(guān)鍵詞： 法洛氏四聯(lián)癥 實時三維超聲心動圖 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》2014年碩士論文　論文類型：學位論文

【摘要】：法洛氏四聯(lián)癥（TOF）是先天性心臟病中較多見的右-左分流型紫紺型心臟病。室間隔缺損，右心室肥厚，肺動脈高壓，主動脈騎跨成為其主要的病理變化。超聲心動圖可以對法洛氏四聯(lián)癥做出正確的診斷，使我們對疾病能夠得出形象的認識。隨著醫(yī)療影像技術(shù)的不斷更新和應用于臨床,實時三維超聲心動圖（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確的依據(jù)和憑證。其能夠即時的呈現(xiàn)心臟的具體形態(tài)和結(jié)構(gòu)，且可通過分割心臟的不同平面，對心臟不同角度的測量，完整的顯示心臟病變的位置，大�。徊∽冎車呐応P(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。因此右心功能的準確評價對于臨床具有非常重要的現(xiàn)實意義，尤其是在對法洛氏四聯(lián)癥患者診斷和治療的過程中意義非凡。心肌功能指數(shù)，即Tei指數(shù)［1］，作為超聲心動圖中的一個衡量指標是即射血分數(shù)之后又一個反應心臟功能的數(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之一，使用超聲心動圖測量右心功能指數(shù)，方便，快捷且對患者不會造成創(chuàng)傷，用其估測法洛氏四聯(lián)癥患者根治術(shù)前后的右心室功能狀態(tài)及其變化，以便指導臨床治療和觀察臨床預后。 目的： 1研究使用ＲＴ－３ＤＥ評估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)（右心室射血分數(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ＴＯＦ患者的右心結(jié)構(gòu)的測量和右心功能的測量方面的相關(guān)性,以便指導臨床手術(shù)治療。 3研究應用心肌功能指數(shù)對法洛氏四聯(lián)癥患者右心功能評價的臨床指導意義。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)補片修補和單純流出道補片修補）對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)所用的時間，心臟直視下心肺轉(zhuǎn)流時間，氣管插管及無創(chuàng)正壓通氣輔助時間，，重癥監(jiān)護室停留時間和術(shù)后極化液營養(yǎng)心肌時間；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檢查和實時三維超聲心動圖檢查。使用兩種方法分別測量右心室舒張末容量，收縮末容量，計算射血分數(shù)；比較兩種檢查方式的相關(guān)性。術(shù)后3個月和6個月均測量手術(shù)后患者右心室心肌功能指數(shù)，同時應用實時三維超聲心動圖測量右心室舒張末容量，收縮末容量，推算右心室射血分數(shù)。將術(shù)前和術(shù)后不同階段（術(shù)后3個月及術(shù)后6個月）所測量的數(shù)據(jù)進行對比分析。測量所得數(shù)據(jù)均應用均數(shù)±標準差（x±s）表示。應用spss13.0軟件進行統(tǒng)計學分析處理。 結(jié)果： 130例患者的比較手術(shù)時長，體外循環(huán)機轉(zhuǎn)機時間，氣管插管及無創(chuàng)正壓通氣輔助時間，重癥監(jiān)護室停留時間和術(shù)后極化液營養(yǎng)心肌時間差異均無統(tǒng)計學意義；手術(shù)時長105±23.5min，體外循環(huán)轉(zhuǎn)機時間79.5±19.4min，氣管插管及無創(chuàng)正壓通氣輔助時間50.1±7.2h，重癥監(jiān)護室停留時間3.8±1.6d和術(shù)后極化液營養(yǎng)心肌時間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個月和術(shù)后第6個月，將所有行法洛氏四聯(lián)癥一期根治術(shù)的患者，進行實時三維超聲心動圖檢查，所測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)癥患者實時三維超聲心動圖所測右心室數(shù)據(jù)與64排螺旋CT三維重建所測得的RVEDV,RVESV及RVEF數(shù)值相關(guān)性良好；實時三維超聲心動圖計算出的右心室射血分數(shù)EF值與64排螺旋CT所測McGoon值呈線性相關(guān)。 3術(shù)后3個月和后6個月，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)計學意義（P0.05）。法洛氏四聯(lián)癥根治術(shù)后第6個月與和術(shù)后第3個月相比Tei指數(shù)明顯減小，差異有統(tǒng)計學意義。（P0.01） 430例法洛氏四聯(lián)癥患者中單純采用流出道補片修補的共7例,使用夸環(huán)修補的共23例，隨訪患者術(shù)后第3個月和術(shù)后第6個月心功能狀態(tài)，單純采用流出道修補的右心室等容舒張時間及等容收縮時間較夸環(huán)修補的縮短，TEI指數(shù)下降，兩者有統(tǒng)計學意義（P0.05） 結(jié)論： 1實時三維超聲心動圖及其右心功能指數(shù)可以確切的評估法洛氏四聯(lián)癥患者的右心功能狀態(tài)。 2實時三維超聲心動圖與MRI所測得的右心室數(shù)據(jù)相關(guān)性良好，右心功能指數(shù)和右心室射血分數(shù)可間接映射出疾病對肺動脈的作用影響。實時三維超聲心動圖為TOF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的手術(shù)方式對右心功能影響較小，手術(shù)方式的不同對右心功能指數(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：1554634