彩色多普勒超声心动图在中老年动脉导管未闭介入治疗中的价值  

Value of color Doppler echocardiography in the interventional treatment of patent ductus ateriosus in patients over 40 years old

作　　者：侯传举[1] 胡斌 邓东安[1] 朱鲜阳[1] 韩秀敏[1] 王琦光[1] 张端珍[1] 

机构地区：[1]中国人民解放军沈阳军区总医院先心病内科,辽宁省沈阳市110840 [2]辽宁省武警总队医院,辽宁省沈阳市110034

出　　处：《实用老年医学》2012年第6期456-458,465,共4页Practical Geriatrics

摘　　要：目的探寻彩色多普勒超声心动图(CDE)在中老年动脉导管未闭(PDA)介入治疗中的价值。方法应用CDE筛选155例中老年PDA,用彩色多普勒血流显像(CDFI)估测PDA肺动脉端直径与心血管造影测量PDA肺动脉端直径进行统计学相关检验,观察CDFI估测PDA直径的准确性,所有患者均行经皮穿刺封堵术介入治疗,术后再用CDE观察介入治疗效果。结果根据CDE特征对所有中老年PDA患者全部做出正确诊断,根据CDE筛选155例中老年PDA实施介入治疗全部获得成功。中老年PDA的CDE特征和规律性明显:(1)M型超声和二维超声心动图显示左心房(93.5%)、左心室(51.6%)内径不同程度增大,室间隔与左室后壁运动幅度增大。(2)所有患者CDFI均显示过动脉导管左向右五彩镶嵌分流束血流信号。(3)根据CDFI测量PDA肺动脉端分流束血流信号宽度判断PDA肺动脉端直径与心血管造影对照,二者呈显著正相关(r=0.73,P<0.001)。(4)中老年PDA合并心脏瓣膜关闭不全明显增多,其中二尖瓣关闭不全(78.7%)、主动脉瓣关闭不全(61.3%)、三尖瓣关闭不全(34.8%)、肺动脉瓣关闭不全(30.3%)。(5)中老年PDA合并肺动脉高压明显增多(46.5%)。(6)中老年PDA患者女性(83.9%)明显多于男性(16.1%)。结论中老年PDA的CDE特征和规律性明显,CDE在中老年PDA介入治疗中具有重要价值。Objective To evaluate the value of color Doppler echocardiography （CDE） in occlusion of patent ductus arteriosus （PDA） in patients over 40 years old. Methods One hundred and fifty-five patients over 40 years old with PDA were examined by CDE to find out the statistic correlation of the PDA diameter on the end of pulmonary artery measured by CDFI and by angiocardiography, to evaluate the accuracy of CDFI. All cases underwent percutaneous occlusion treatment. The occlusion effect was studied by CDFI after operation. Results All cases were accurately diagnosed by imaging characteristics of CDE. The features and regularities of PDA over 40 years were obvious： （1） M-mode echocardiographic and two-dimensional echocardiography showed enlarged left atrium（93.5%） and left ventricle（51.6%）. The movement of ventricular septum and left ventricular post erior wall increased. （2） Color Doppler flow imaging showed colorful shunt through the patent ductus arteriosus. （3）The diameter on the end of pulmonary artery measured by angiocardiography and by CDE was highly related （r=0.73, P0.001）. （4） PDA combined with cardiac valve insufficiency increased obviously among patients over 40 years old, with mitral insufficiency（78.7%）, aortic insufficiency（61.3%）, tricuspid insufficiency（34.8%） and pulmonary insufficiency（30.3%）. （5） PDA combined with pulmonary arterial hypertension（46.5%） increased obviously among patients over 40 years old.（6） The incidence of PDA over 40 was much higher in female（83.9%） than that in male（16.1%）. Conclusions The CDE characteristics and regularity of PDA among patients over 40 years old is obvious. CDE plays a very important role in PDA patients over 40 years old receiving interventional treatment.

关 键 词：先天性心脏缺损 动脉导管未闭 彩色多普勒超声心动图 心血管造影术 介入治疗 

分 类 号：R543.1[医药卫生—心血管疾病] R445.1[医药卫生—内科学]