超声心动图对主动脉缩窄伴左心室收缩功能降低患者的诊断及术后随访价值  

Echocardiographic diagnosis and post-operative evaluation of coarctation of aorta accompanied by left ventricular systolic dysfunction

作　　者：张鑫[1] 马桂琴[1] 金兰中[1] 王芳韵[1] 郑淋[1] 卫海燕[1] 

机构地区：[1]首都医科大学附属北京儿童医院心脏中心,100045

出　　处：《中华医学超声杂志（电子版）》2014年第8期20-23,共4页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨伴有左心室收缩功能降低患者主动脉缩窄的特点以及超声心动图在其诊断、术后随访中的临床应用价值。方法选取我院主动脉缩窄患者102例,根据左心室射血分数(EF)数值将其分为EF降低组(EF<60%)及EF正常组(EF≥60%),通过比较两组患者超声表现,总结伴有左心室收缩功能降低的主动脉缩窄的特点。对EF降低组中手术者分别于术后1 d、术后1个月和术后6个月行超声心动图随诊,并与术前对比。结果 EF降低组17例,经增强CT或手术证实,超声确诊15例,误诊2例。EF降低组与EF正常组相比,孤立型主动脉缩窄多见,往往伴左心室舒张末期内径重度增大、左心室心内膜回声粗糙、冠状动脉近段内径增宽,两组比较差异有统计学意义(χ2=8.745、13.246、32.750、8.330,P均<0.05);两组在狭窄程度、缩窄形态、室间隔及室壁增厚构成上差异无统计学意义(Z=-1.532,χ2=0.222、0.678,P均>0.05)。EF降低组中12例患者经手术矫治并术后超声随诊,术后1 d、1个月、6个月各时段狭窄修复处内径及压差、左心室舒张末期内径与术前比较差异均有统计学意义(t=-9.969、-9.987、-11.265,t=6.463、5.108、5.632,t=4.986、5.713、7.219,P均<0.05)。左心室EF值在术后1 d与术前比较差异无统计学意义(t=-2.217,P>0.05);在术后1个月、术后6个月与术前比较差异有统计学意义(t=-3.999、-9.198,P均<0.05),术后6个月左心室EF值均值>60%。结论伴有左心室收缩功能降低的主动脉缩窄有特征性超声表现,超声心动图对其诊断及术后评价具有重要价值。Objective To evaluate the echocardiographic diagnosis and post-operative evaluation of coarctation of aorta accompanied by left ventricular systolic dysfunction. Methods According to the measurement of left ventricular ejection fraction, 102 patients were divided into two groups： reduced ejection fraction（EF） group（EF 60%） and normal EF group（EF ≥ 60%）. The data of the two groups were compared by statistical analysis. Post-operative patients of the reduced EF group were followed up by echocardiography. The data of 1 day, 1 month and 6 months after operation were compared with pre-operative data respectively. Results There were 17 cases in the reduced EF group which confirmed by CT or surgery. Fifteen cases were diagnosed by echocardiography. The statistical analysis showed： compared with the normal EF group, the reduced EF group had more cases of isolated coarctation of aorta, the constituent ratio of left ventricular end-diastolic diameter increased severely, abnormal endocardium and widen adjacent segment of coronary arteries of the two groups had significant statistical difference（χ2=8.745, 13.246, 32.750, 8.330, all P0.05）; the morphological characteristics of the coarctation, the degree of stenosis and left ventricular hypertrophy of the two groups had no significant statistical difference（Z=-1.532, χ2=0.222, 0.678, all P0.05）; 12 patients of the reduced EF group underwent surgical correction. The statistical analysis showed： compared with pre-operative, the diameter and the pressure of the coarctation, left ventricular end-diastolic diameter on the first day after operation and at 1 month, 6 months after operation had significant statistical difference（t=-9.969,-9.987,-11.265, t=6.463, 5.108, 5.632, t=4.986, 5.713, 7.219, all P0.05）. Compared with pre-operative, the measurement of left ventricular ejection fraction on the first day after operation had no significant statistical difference（t=-2.217, P0.05）; the measurement of left ventricular ejection fraction at 1 month

关 键 词：主动脉缩窄 心室功能障碍 左 超声心动描记术 压力 

分 类 号：R445.1[医药卫生—影像医学与核医学]