法洛四联症患儿手术前超声心动图Z值研究  

The Z scores value of cardiac structure by preoperative echocardiography in children with tetralogy of Fallot

作　　者：陈伟玲[1] 夏焙[1] 于红奎[1] 许娜[1] 

机构地区：[1]汕头大学医学院附属深圳市儿童医院超声影像科,518026

出　　处：《中华医学超声杂志（电子版）》2015年第7期545-550,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨法洛四联症(TOF)患儿术前超声心动图的Z值变化及其临床应用的意义。方法回顾性分析2011年1月至2013年9月在深圳市儿童医院手术治疗的31例TOF患儿术前超声心动图结果,患儿年龄中位数10个月(3 d^14岁);取同期31例健康儿童为正常对照组,年龄中位数10个月(6 d^13岁)。超声心动图测量内容包括右心室流出道(RVOT)、肺动脉瓣环(PVD)、左肺动脉(LPAD)、右肺动脉(RPAD)、肺动脉瓣口峰值流速(PV-Vmax)、三尖瓣环内径(TVD)、二尖瓣环内径(MVD)、左心室舒张末期容积(LVEDV)和左心室心肌质量(LVmass)。应用深圳市儿童医院小儿超声心动图正常参考值及其回归方程式获得各参数的预测平均值,用Z值公式转为标准值(Z=[M-y]/MSE)。结果 TOF组与对照组的体表面积,差异无统计学意义(P>0.05)。与对照组比较,TOF组RVOT直径显著减小、Z值呈负值增大(-4.87±1.86 vs 0.33±0.93,t=-13.90,P<0.05);TOF患儿的PVD、LPAD、RPAD显著减小,相应的Z值均呈负值增大(-4.15±2.93 vs0.11±0.85,t=-7.76;-1.35±2.38 vs 0.66±1.17,t=-4.24;-1.47±2.03 vs 0.59±1.04,t=-4.94,P值均<0.05);而PV-Vmax显著增大,相应的Z值增大,差异有统计学意义(8.38±0.19 vs 0.24±0.98,t=29.50,P<0.05)。TOF组TVD略大于对照组(P=0.10),但其Z值比对照组增大,差异有统计学意义(1.00±1.17 vs 0.29±0.52,t=3.06,P<0.05)。TOF患儿的MVD、LVEDV、LVmass均有减小趋势,差异无统计学意义(P>0.05),但其Z值均明显减小,差异均有统计学意义(0.25±0.78 vs0.76±0.65,t=-2.75;-0.92±1.94 vs 0.03±1.01,t=-2.41;-0.83±1.59 vs 0.67±0.69,t=-4.71,P值均<0.05)。与行肺动脉瓣环扩张术相比,行跨肺动脉瓣补片术患儿的RVOT、PVD、LPAD、RPAD稍减小,Z值呈负值增大,差异均无统计学意义(-4.89±2.03 vs-4.84±1.67,t=-0.08;-4.73±3.49vs-3.34±1.75,t=-1.31;-1.88±2.54 vs-0.62±2.00,t=-1.49;-1.89±1.90 vs-0.84±2.15,t=-1.41,P值均>0.05);行跨瓣补片术患儿的PV-Vmax稍增快,PV-Vmax Z值呈正值增�Objective To evaluate the value and clinical application of cardiac structure Z scores in children with preoperative tetralogy of Fallot （TOF） by echocardiography. Methods Considering the result of 31 patients who underwent echocardiography in Shenzhen Children’s Hospital before TOF repair from January 2011 to September 2013, the median age was 10 months （range：3 days to 14 years）. Other 31 normal children were selected as normal control group with age-and sex-matched, the median age was＆amp;nbsp;10 months （range： 6 days to 13 years）. Echocardiographic measurements included the diameter of right ventricular outflow tract （RVOT）, pulmonary valve diameter （PVD）, left pulmonary artery diameter （LPAD）, right pulmonary artery diameter （RPAD）, pulmonary valve peak velocity （PV-Vmax）, tricuspid annulus diameter （TVD）, mitral annulus diameter （MAD）, left ventricular end-diastolic volume （LVEDV） and left ventricular mass （LVmass）. Shenzhen Children’s Hospital pediatric echocardiography normal reference values and the regression equation are applied to obtain the forecast average, and using the Z-score formula into the standard value （Z=[M-y]/ MSE ）. Results There was no significant difference in body surface area between the TOF group and control group （P＆gt;0.05）. Compared with control group, the true value of RVOT reduced significantly in TOF group, its Z-score showed negative values increase （-4.87±1.86 vs 0.33±0.93, t=-13.90, P〈0.05）. PVD, LPAD and RPAD reduced significantly in TOF group, those Z scores showed a negative value increase （-4.15±2.93 vs 0.11±0.85, t=-7.76;-1.35±2.38 vs 0.66±1.17, t=-4.24;-1.47±2.03 vs 0.59±1.04, t=-4.94;all P〈0.05）. While PV-Vmax increased significantly, and it’s Z score showed a positive value increase （8.38±0.19 vs 0.24±0.98, t=29.50, P〈0.05）. TVD of TOF patients was slightly larger than the control group （P=0.10）, but the Z score was significant greater than the control group （1.00�

关 键 词：超声心动图 Z值 法洛四联症 儿童 

分 类 号：R726.5[医药卫生—儿科] R540.45[医药卫生—临床医学]