【摘要】：[目的]評(píng)價(jià)二維超聲心動(dòng)圖(Two-dimensional echocardiography,2-DE)定性與定量診斷房間隔缺損(Atrial septal defect,ASD)、室間隔缺損(Ventricular septal defect,VSD)、動(dòng)脈導(dǎo)管未閉(Patent ductus arteriosus,PDA)在經(jīng)導(dǎo)管缺損封堵術(shù)的價(jià)值�？偨Y(jié)超聲心動(dòng)圖測量ASD、VSD、PDA缺口的方法。[方法]選取2014年1月～2016年12月在昆明醫(yī)科大學(xué)第一附屬醫(yī)院經(jīng)TTE初步診斷為ASD患者523例,其中男174例,女349例,年齡1～71歲,平均年齡30.78±19.20歲。275例(52.6%)術(shù)前單純由TTE篩選,248例(47.4%)術(shù)前由TTE和TEE共同篩選,所有患者術(shù)前TTE和(或)TEE的診斷與術(shù)后診斷對(duì)比,TTE、TEE測量ASDmax分別與封堵器腰徑直徑做相關(guān)性分析,建立線性回歸方程。102例患者術(shù)前TTE對(duì)軟邊ASDmax、硬邊ASDmax測量,TTE測量軟邊ASDmax、硬邊ASDmax、TEE測量ASDmax分別與封堵器腰徑直徑做相關(guān)性分析,建立線性回歸方程。選取2014年1月～2016年12月在昆明醫(yī)科大學(xué)第一附屬醫(yī)院經(jīng)TTE初步診斷為VSD的患者170例,其中男87例,女83例,年齡2～63歲,平均年齡15.76±15.80歲。所有病例對(duì)TTE的診斷與術(shù)后診斷對(duì)比。170例術(shù)前由TTE篩選的VSD患者,將術(shù)前行TTE測量VSD左室側(cè)、右室側(cè)、腰部缺口寬度分別與封堵器腰徑做相關(guān)性分析,建立回歸方程。選取2014年1月～2016年12月在昆明醫(yī)科大學(xué)第一附屬醫(yī)院經(jīng)TTE初步診斷為PDA的患者160例,其中男47例,女113例,年齡1～68歲,平均年齡15.44±15.03歲。所有病例對(duì)TTE的診斷與術(shù)后診斷對(duì)比。160例術(shù)前由TTE篩選的VSD患者,將TTE測量PDADao與封堵器主動(dòng)脈側(cè)直徑及TTE測量PDADPa與封堵器肺動(dòng)脈側(cè)直徑分別做相關(guān)分析,建立回歸方程。[結(jié)果]1.術(shù)前單純由TTE篩選ASD患者準(zhǔn)確率(100%)與術(shù)前由TTE和TEE共同篩選的ASD患者的準(zhǔn)確率(100%)無統(tǒng)計(jì)學(xué)差異(P0.05),TTE即可準(zhǔn)確診斷ASD。TTE術(shù)前診斷單純性VSD的準(zhǔn)確率為100%。TTE術(shù)前診斷PDA的準(zhǔn)確率為100%。2.TTE測量ASDmax與ASO腰徑直徑的關(guān)系:TTE測量ASDmax(14.0±6.5mm)與封堵器腰徑(20.2±6.8mm)有統(tǒng)計(jì)學(xué)差異(P0.05),TTE測量ASDmax與ASO腰徑之間具有相關(guān)性(r=0.7,P0.001),回歸方程:Y= 9.835 + 0.737x(P0.05)。3.TTE和TEE測量ASDmax與ASO腰徑直徑關(guān)系:TTE、TEE測量ASDmax(17.1±7.2mm,19.6±8.1mm)分別與 ASO 腰徑(25.8±7.3mm)之間存在統(tǒng)計(jì)學(xué)差異(P0.05),TTE和TEE測量ASDmax與ASO腰徑均具有相關(guān)性(r=0.670,P0.001;r=0.716,P0.001),TEE 測量 ASDmax 與 ASO 之間相關(guān)性較好,回歸方程:TTE 與 ASO 腰徑:Y=14.176+0.681x(P0.05);TEE 與 ASO 腰徑:Y=13.236+0.643x(P0.05)。4.TTE測量軟邊ASDmax、硬邊ASDmax分別與ASO腰徑關(guān)系:軟邊ASDmax(12.3±5.3mm)、硬邊ASDmax(17.8±5.4mm)分別與ASO腰徑(19.8±6.9mm)之間存在統(tǒng)計(jì)學(xué)差異(P0.05),TTE測量軟邊ASDmax、硬邊ASDmax分別與ASO腰徑之間均具有相關(guān)性(r=0.718,P0.001;r=0.723,P0.001),TTE測量硬邊ASDmax與ASO之間相關(guān)性較好;回歸方程:TTE測量軟邊 ASDmax 與 ASO 腰徑:Y = 8.220 + 0.938x(P0.05),TTE 測量硬邊ASDmax 與 ASO 腰徑:Y = 3.454 + 0.921x(P0.05)。5.TTE測量軟邊ASDmax、硬邊ASDmax、TEE測量ASDmax與ASO腰徑關(guān)系:TTE 測量軟邊 ASDmax(18.2±7.4mm)、硬邊 ASDmax(24.1±7.1mm)、TEE測量ASDmax(20.9±8.0mm)分別與ASO腰徑(27.4±7.3mm)之間存在統(tǒng)計(jì)學(xué)差異(P0.05);TTE測量軟邊ASDmax、硬邊ASDmax、TEE測量ASDmax分別與ASO腰徑之間均具有相關(guān)性(r=0.790,P0.001;r=0.741,P0.001;r = 0.739,P0.001);TTE測量軟邊ASDmax與ASO之間相關(guān)性最好;回歸方程:TTE 測量軟邊 ASDmax 與 ASO 直徑:Y=13.253 + 0.775x(P0.05),TTE 測量硬邊 ASDmax 與 ASO 直徑:Y=8.936+0.765x(P0.05),TEE 測量ASDmax 與 ASO 直徑:Y=13.245+0.674x(P0.05)。6.TTE測量VSD左室側(cè)、右室側(cè)、腰部缺口寬度與VSO腰徑關(guān)系。VSO腰徑(8.2±2.7mm)與TTE測量VSD左室側(cè)缺口寬度(8.4±3.1mm)之間無統(tǒng)計(jì)學(xué)差異(P0.05),TTE測量右室側(cè)(6.6±2.6mm)、腰部缺口寬度(6.3±2.0mm)與VSO腰徑(8.2±2.7mm)之間存在統(tǒng)計(jì)學(xué)差異(P0.01);TTE測量VSD左室側(cè)、右室側(cè)、腰部缺口寬度分別與VSO腰徑之間具有相關(guān)性(r=0.559,P0.001;r=0.481,P0.001;r=0.362,P0.001),TTE 測量 VSD 左室側(cè)缺口寬度與VSO之間相關(guān)性大于TTE測量右室側(cè)、腰部缺口寬度;回歸方程:TTE測量 VSD 左室側(cè)缺口寬度與 VSO 腰徑:Y = 4.073 + 0.489x(P0.05);TTE測量 VSD 腰部缺口 寬度與 VSO 腰徑:Y=4.085 + 0.657x(P0.05);TTE 測量 VSD 右室側(cè)缺口寬度與 VSO 腰徑:Y=5.705+0.376x(P0.05)。7.TTE測量PDADao與ADO主動(dòng)脈側(cè)的關(guān)系,及TTE測量PDADPa與ADO肺動(dòng)脈側(cè)之間的關(guān)系。TTE測量PDADao(8.5±3.9mm)與ADO主動(dòng)脈側(cè)(12.0±4.4mm)、TTE 測量 PDADPa(8.0±4.2mm)與 ADO 肺動(dòng)脈側(cè)(10.5±4.2mm)之間存在統(tǒng)計(jì)學(xué)差異(P0.01);TTE測量PDADao與ADO主動(dòng)脈側(cè)直徑、TTE測量PDADPa與ADO肺動(dòng)脈側(cè)直徑之間具有相關(guān)性(r=0.721,P0.001;r=0.653,P0.001),TTE測量PDADao與ADO主動(dòng)脈側(cè)直徑相關(guān)性程度較高;回歸方程:TTE測量PDADao與ADO主動(dòng)脈側(cè):Y=5.159+0.809x(P0.05);TTE 測量 PDADPa 與 ADO 肺動(dòng)脈側(cè):Y=5.255+0.656x(P0.05)。[結(jié)論]1.二維超聲心動(dòng)圖能準(zhǔn)確定性診斷房間隔缺損、室間隔缺損、動(dòng)脈導(dǎo)管未閉。2.TTE、TEE測量ASDmax分別與ASO腰徑均有相關(guān)性,但TEE測值指導(dǎo)選擇封堵器腰徑較,TTE更為可靠;TTE測量軟邊ASDmax、硬邊ASDmax、TEE測量ASDmax分別與ASO腰徑都具有相關(guān)性,TTE測量硬邊ASDmax與ASO之間相關(guān)程度高,推薦在TTE測量ASDmax時(shí),應(yīng)對(duì)完全無支持力的極軟邊剔除。3.TTE測量VSD左室側(cè)、右室側(cè)、腰部缺口寬度分別與VSO腰徑均有相關(guān)性,TTE測量VSD左室側(cè)與VSO腰徑的相關(guān)程度高,TTE測量VSD左室側(cè)缺口寬度指導(dǎo)選擇封堵器腰徑較為可靠。4.TTE測量PDADao與ADO主動(dòng)脈側(cè)直徑及TTE測量PDADPa與ADO肺動(dòng)脈側(cè)直徑均有統(tǒng)計(jì)學(xué)差異和相關(guān)性,TTE測量PDADao與封堵器主動(dòng)脈側(cè)直徑的相關(guān)性較高,建議依據(jù)PDADao指導(dǎo)封堵器腰徑的選擇。
[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.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R54

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 陳思佳;郭盛蘭;蘇虹月;王茜;陸中智;覃詩耘;;經(jīng)胸超聲心動(dòng)圖帶軟邊測量法評(píng)價(jià)房間隔缺損大小及指導(dǎo)封堵器型號(hào)選擇的準(zhǔn)確性分析[J];臨床心血管病雜志;2015年10期

2 禹紀(jì)紅;金敬琳;李世國;徐仲英;張戈軍;呂斌;劉瓊;宋會(huì)軍;蔣世良;;先天性心臟病心導(dǎo)管及心血管造影檢查死亡病例分析[J];心肺血管病雜志;2015年03期

3 金梅;;先天性心臟病介入性治療回顧與進(jìn)展[J];心肺血管病雜志;2011年05期

4 張玉順;;常見先天性心臟病介入治療中國專家共識(shí) 三、動(dòng)脈導(dǎo)管未閉的介入治療[J];介入放射學(xué)雜志;2011年03期

5 秦永文;;常見先天性心臟病介入治療中國專家共識(shí) 二、室間隔缺損介入治療[J];介入放射學(xué)雜志;2011年02期

6 朱鮮陽;;常見先天性心臟病介入治療中國專家共識(shí) 一、房間隔缺損介入治療[J];介入放射學(xué)雜志;2011年01期

7 王春鳳;董志;辛鴻飛;;經(jīng)胸彩超對(duì)先心病介入封堵術(shù)治療的應(yīng)用價(jià)值[J];中國臨床醫(yī)學(xué)影像雜志;2009年01期

8 張軍;李軍;李利;石晶;姚志勇;朱霆;張玉順;左健;代政學(xué);李寰;;經(jīng)胸超聲心動(dòng)圖指導(dǎo)硬緣房間隔缺損封堵術(shù)[J];中華超聲影像學(xué)雜志;2006年03期

9 李軍,張軍,姚志勇,張玉順,劉建平,左健,朱霆;經(jīng)胸超聲心動(dòng)圖在室間隔缺損封堵術(shù)中的應(yīng)用研究[J];中國超聲醫(yī)學(xué)雜志;2003年10期

10 張玉順,代政學(xué),賈國良,張軍,李寰,王小燕;根據(jù)食道超聲心動(dòng)圖測量值選擇封堵器介入治療房間隔缺損——Amplatzer封堵法改良Ⅰ[J];第四軍醫(yī)大學(xué)學(xué)報(bào);2001年21期

相關(guān)博士學(xué)位論文 前1條

1 朱振輝;綜合超聲心動(dòng)圖技術(shù)在室間隔缺損經(jīng)導(dǎo)管封堵治療中的應(yīng)用研究[D];中國協(xié)和醫(yī)科大學(xué);2005年

相關(guān)碩士學(xué)位論文 前4條

1 陸中智;經(jīng)胸超聲心動(dòng)圖在經(jīng)導(dǎo)管介入室間隔缺損封堵術(shù)中的臨床應(yīng)用分析[D];廣西醫(yī)科大學(xué);2014年

2 周建華;超聲心動(dòng)圖與心血管造影測量動(dòng)脈導(dǎo)管未閉的對(duì)比性研究[D];天津醫(yī)科大學(xué);2014年

3 王靜;超聲測量動(dòng)脈導(dǎo)管未閉內(nèi)徑可靠性的臨床對(duì)比研究[D];重慶醫(yī)科大學(xué);2013年

4 沈艷;超聲心動(dòng)圖在先天性心臟病房間隔缺損封堵術(shù)中的臨床應(yīng)用研究[D];昆明醫(yī)學(xué)院;2008年

，

本文編號(hào)：2184185