超声心动图、多普勒超声心肌工作指数及组织多普勒成像无创评估左心室型单心室患儿心功能变化对比研究  

Comparative study on heart function assessment of left single ventricle in children by echocardiography, doppler myocardial performance index and tissue doppler imaging

作　　者：王珊珊 张玉奇[1] 张志芳[1] 武育蓉 吴兰平[1] 钟舒文 陈丽君[1] 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心心内科,200127

出　　处：《中华实用儿科临床杂志》2013年第13期983-986,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：上海市科委医学引导类项目（10411965300）;上海市教委科研创新项目重点项目（13ZZ081）

摘　　要：目的 探讨三维超声心动图（3DE）、多普勒超声心肌工作指数（MPI）及组织多普勒成像（TDI）无创评估左心室型单心室患儿心功能的准确性。方法 左心室型单心室患儿29例为病例组，29例健康儿童为健康对照组。应用三维超声（Q-lab软件）分析并计算左心室型单心室患儿主心腔及健康儿童左心室的舒张末期容积（EDV）、收缩末期容积（ESV）、射血分数（EF）；根据心室流入道及流出道的血流频谱计算左心室型单心室患者与健康儿童的MPI；应用TDI检测病例组和健康对照组儿童的房室瓣环运动速度等指标；将以上3类指标与根据房室瓣反流频谱测得的单心室峰值压力变化率 Max（dp/dt）进行对比分析。结果 病例组患儿的 EDV、ESV及MPI均较健康对照组明显升高（t=2.821、5.287、2.085，P均 〈0.05）；病例组的 EF较健康对照组明显降低（t= -13.840，P 〈0.05）。对照组二尖瓣环左心室侧壁舒张早期最大峰值速度（Em）、舒张晚期最大峰值速度（Am）和Em /Am 高于病例组非残余心腔侧（t= -3.059、2.219、-4.762，P 〈0.05）；对照组二尖瓣环室间隔侧收缩期最大峰值速度（Sm）和Em /Am 高于病例组残余心腔侧（t= -2.200、-2.962，P 〈0.05）。对照组Q-Sm 间期显著低于病例组（t=2.345，P 〈0.05）。病例组的 Max（dp/dt）与病例组 MPI呈负相关（r= -0.57，P 〈0.05），与病例组EF和Q-Sm 间期呈正相关（r=0.74、0.62，P 〈0.01）。结论 左心室型单心室患儿存在心功能不全，3DE可比较准确地反映左心室型单心室患儿的心功能变化。Objective To explore the accuracy of heart function assessment of the left single ventricle prob-lems in children by three-dimensional echocardiography（ 3DE ） , the doppler myocardial performance index （MPI） and tissue doppler imaging（TDI）. Methods Twenty-nine healthy children （the healthy control group ） and 29 children with problems in the single left ventricles （the case study group） were enrolled in this study. End-diastolic volume （EDV） ,end-systolic volume（ESV） and ejection fraction（EF） were acquired by using IE 33 system and Q-lab software between 2 groups. MPI was calculated from doppler tracings on the ventricular inflow and outflow, and the velocity pro- file of atrioventricular annular was obtained by TDI. Max（dp/dt） of the left single ventricle was estimated by atrioven-tricular regurgitation using simplified Bernoulli equation. Results EDV, ESV and MPI in the case study group were higher than those of the healthy control group（ t = 2. 821,5. 287,2. 085, all P 〈 0.05 ）, and EF of the case study group was lower than that of the healthy control group （ t = - 13. 840,P 〈 0. 05 ）. Em, Am and Ern/Am on the side of the left ventricular lateral wall of mitral annulus in the control group were higher than those of the case study group at the non-residual cardiac cavity side（t = -3. 059,2. 219, -4. 762 ,P 〈 0.05 ） ;Sm and Era/Am in the healthy control group at mitral annular lateral ventricular septal side were higher than those in the case study group at the residual cardiac cavity side（t = -2.200, -2. 962,P 〈0.05）. Q-Sm interval in healthy control group was lower than that in the case study group （ t = 2. 345, P 〈 0.05 ）. There was a negative correlation between Max （dp/dt） and MPI in the case study group （r = -0. 57,19 〈 0.05 ）, there was a positive correlation between Max（dp/dt） and EF and Q-Sm interval in the case study group（ r = -0.74,0.62, P 〈 0.05 ）. Conclusions Impaired ventricular functions can be found in patients

关 键 词：超声心动图 左心室型单心室 心功能 

分 类 号：R445.1[医药卫生—影像医学与核医学]