超声心动图对体肺分流术的评价和随访  

Echocardiographic Evaluation and Follow up Study for Modified Blalock-Taussig Shunts and Central Shunts in Patients With Complex Congenital Heart Disease

作　　者：施怡声[1] 王浩[1] 李建蓉[1] 李永青[1] 蒋丽[1] 李守军[2] 

机构地区：[1]中国医学科学院北京协和医学院心血管病研究所阜外心血管病医院超声科,北京市100037 [2]中国医学科学院北京协和医学院心血管病研究所阜外心血管病医院小儿心脏外科中心,北京市100037

出　　处：《中国循环杂志》2009年第6期454-457,共4页Chinese Circulation Journal

基　　金：中央级公益性科研院所基金2009F-009

摘　　要：目的:体肺分流术是复杂紫绀型先天性心脏病(先心病)的主要姑息手术之一,主要包括改良体肺分流术(BT)和中央分流术(CS)两类。本文回顾性总结超声心动图对不同体肺分流术式和体肺分流术后的评价及中期随访。方法:选择体肺分流术后随访6个月以上的患者资料共87例,其中改良体肺分流术(BT组)42例,中央分流术(CS组)45例,超声心动图检查分别记录手术前后的肺动脉内径及左心室舒张末期前后径变化,分流管道的血流速度和管道通畅情况。结果:两组共7例患者术后当天接受急诊手术对管道进行重新处理。BT组术后平均随访(22.3±12.1)个月,CS组术后平均随访(26.0±21.3)个月。随访期间前者(BT组)有8例发生堵塞,后者(CS组)有6例。分流手术后,左心室前后径扩大CS组为(8.9±3.5)mm较BT组(6.6±5.1)mm显著增加,差异有统计学意义(P=0.03);而两组主肺动脉内径增加值比较差异无统计学意义[(3.1±2.2)mm vs.(1.7±1.8)mm)]。术后随访期间接受后期矫治手术两组分别为BT组24例和CS组27例,手术率比较差异无统计学意义[57.1%(24/42)vs 60.0%(27/45),P>0.05]。结论:本研究表明两组体肺分流术式都可以促进肺血管和左心室的发育。超声心动图检查在不同术式的体肺分流的术后近期监测及远期随访研究中起着重要的作用。Objective： Placement of modified blalock-tasussig （BT） shunts and central shunts （CS） were the staging procedure to provide controlled pulmonary blood flow for the patients with complex congenital heart disease. We summarized our experience of post-operative and mid-term echocardiographic evaluation for those two procedures. Methods ： A total of 87 consecutive patients were enrolled for two groups according to the shunts they received. Modified BT shunts （ BT group） ,n =42 ,and CS group,n =45. The follow up study was performed 22. 3 ± 12. 1 months in BT group and 26. 0 ± 21.3 months in CS group respectively. Transthoracic echocardiography was utilized to evaluate the patency of shunts and the changes of patients＇ pulmonary arteries（PA） and left ventricles （LV）. Results： There were 7 patients received emergent surgical intervention for the shunts. During the follow up period of time, the obstruction of shunts occurred in 8 patients in BT group and 6 in CS group. There was no difference of PA size increasing between BT and CS group （3. 1 ±2. 2 vs. 1.7 ± 1.8 mm,P 〉0. 05）. However,the LV size increasing in BT group was significantly lower than in CS group （6. 6± 5.1 mm vs. 8. 9± 3.5 mm,P =0. 03）. There were 24 patients received the followed definitive repair or palliative operations in BT group and 27 in CS group, which was not a statistical difference.Conclusion ： Echocardiography accurately visualized the patency of BT or CS and measured the dimensions of PA and LV following shunts placements. Both procedures increased the growth of PA and LV, CS increased the development of LV greater than BT shunts.

关 键 词：复杂性先天性心脏病 分流 超声心动描记术 

分 类 号：R541[医药卫生—心血管疾病]