彩色多普勒超声心动图诊断先天性心脏病的准确性及其对外科手术指导价值的研究  

The value of Color Doppler Echocardiography in guiding surgical repair of congenital heart disease in children: 2786 cases experience

作　　者：陶子瑜[1] 黄国英[1] 林其珊[1] 马晓静[1] 刘晓琴[1] 梁雪村[1] 陈伟达[1] 孙斌[1] 陈张根[1] 贾兵[1] 

机构地区：[1]复旦大学附属儿科医院心血管中心,上海200032

出　　处：《中国循证儿科杂志》2007年第5期338-346,共9页Chinese Journal of Evidence Based Pediatrics

基　　金：卫生部临床学科重点项目(20011827)

摘　　要：目的评价彩色多普勒超声心动图（CDE）诊断先天性心脏病（先心病）的准确性及其对外科手术的指导价值,并探讨该技术的局限性。方法以复旦大学附属儿科医院心血管中心制定的CDE规范化诊断方案对先心病进行检查,每个病例至少显示12个超声切面观,结合VanPraagh顺序节段分析法做出诊断。采用Philips/SONOS7500、HP/SONOS5500或HP/SONOS2500多功能超声诊断仪。以手术诊断为金标准,评价CDE诊断先心病的敏感度、特异度、符合率、阳性预测值和阴性预测值等,并与心导管造影（ANGIO）诊断进行比较。结果2001年1月至2006年12月,接受外科手术治疗的先心病患儿共2786例,其中,复杂病例1046例（占37.6%）;年龄1d至24岁5个月,平均（2.83±2.63）岁;婴幼儿2301例（2301/2786）,占82.59%,〈1岁者38.79%,~3岁者43.79%;围术期死亡35例（1.26%,35/2786）。以手术诊断为金标准,CDE诊断2786例先心病患儿主要畸形的敏感度98.38%,特异度99.97%,符合率99.92%,阳性预测值99.06%,阴性预测值99.95%。在463例同时接受CDE和ANGIO检查的患儿中,计算ANGIO诊断的敏感度99.08%,特异度99.96%,符合率99.92%,阳性预测值99.02%,阴性预测值99.95%;与ANGIO诊断比较,CDE诊断主动脉缩窄的敏感度较低（P=0.036）。结论CDE规范化诊断方案可以对绝大多数先心病做出准确诊断,大部分先心病患儿在CDE检查后可直接施行手术治疗,但如果术前需要了解肺动脉压力/阻力和肺血管发育情况,或CDE诊断不完全明确,或怀疑合并有其他心血管畸形（主动脉缩窄等）,仍然需要进一步接受心导管造影检查。Objective Color Doppler echocardiography （CDE） is ideally suited for the evaluation of congenital heart disease because of its ability to visualize cross sections of complex cardiac anatomic al structures. The purpose of this study was to evaluate the accuracy of color Doppler echocardiography in the diagnosis of congenital heart disease, to provide understanding how echocardiography was helpful in guiding surgical repair, and to investigate the limitation of this technique. Methods From Jan.2001 to Dec.2006, 2 786 patients age ranged from 1 day to 24years [average（ 2.83±2.63 ） years],with congenital heart diseases, who underwent surgical repair, were studied in our hospital. Among them, there were 1 046（37.6%）cases with complex congenital heart diseases,and 2 301 （82.6%） cases under 3 years of age. The perioperative mortality was 1.26%. Philips/SONOS 7500、HP/SONOS 5500 and HP/SONOS 2500 ultrasonic systems were employed for CDE diagnosis. 2 323 （83.4%） patients received directly surgical repair after CDE diagnosis, while 463 （16.6%） patients were required to take angiocardiography as well before surgery. Results As compared with surgical findings, the sensitivity, specificity, reliability, positive predicative value and negative predicative value of CDE in the diagnosis of congenital heart diseases were 98.38%, 99.97%,99.92%, 99.06% and 99.95%, respectively.In the group who received angiocardiography, the sensitivity, specificity, reliability, positive predicative value and negative predicative value of angiocardiography in the diagnosis of congenital heart diseases were 99.08%, 99.96%, 99.92%, 99.02% and 99.95%, respectively. The sensitivity of CDE was significantly lower than angiocardiography in diagnosing coarctation of the aorta （P=0.036）. However, no difference was found between CDE and angiocardiography in other indices. Conclusions CDE is able to make correct diagnosis in most congenital heart diseases, which in offers invaluable decision for surgical repair without further

关 键 词：先天性心脏病 超声心动描记术 彩色血流显像 手术 儿童 

分 类 号：R726.5[医药卫生—儿科]