左心声学造影与实时三维超声心动图评价心肌梗死后室间隔穿孔及死亡相关因素分析  

The evaluation of post-infarction ventricular septal rupture and the risk factors of death by left ventricular opacification and real-time three-dimensional echocardiography

作　　者：赵娜[1] 滑少华[1] 王红鹄 齐清华[1] 杨雨[1] 张瑞芳[1] Zhao Na;Hua Shaohua;Wang Honghu;Qi Qinghua;Yang Yu;Zhang Ruifang(Department of Ultrasound,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院超声科,450052

出　　处：《中华超声影像学杂志》2019年第11期933-939,共7页Chinese Journal of Ultrasonography

摘　　要：目的利用左心声学造影(left ventricular opacification,LVO)联合实时三维超声心动图(real-time three-dimensional echocardiography,RT-3DE)研究心肌梗死后室间隔穿孔(post-infarction ventricular septal rupture,PI-VSR)患者的局部形态及手术前后左心功能,评估影响室间隔穿孔(ventricular septal rupture,VSR)患者死亡的相关危险因素。方法PI-VSR患者28例,手术治疗19例,比较手术患者二维超声、RT-3DE和LVO检测VSR最大径、部位、数目、形状与手术结果的一致性,在LVO条件下联合RT-3DE对比手术前后左心功能指标的变化情况。根据患者一般资料及临床资料探究影响生存预后的独立危险因素。结果①LVO与RT-3DE检测VSR最大径与手术结果比较差异无统计学意义(均P>0.05)。LVO检测VSR部位、数目、形状与手术结果的一致性较好(均P<0.05)。RT-3DE检测VSR部位、形状与手术结果的一致性较好(均P<0.05)。其中LVO对部位和形状的检测与术中结果一致性的Kappa值分别为0.650、0.883。LVO观察VSR形状的敏感性为0.923,特异性为1.000,准确性为0.947,阳性预测值为1.000,阴性预测值为0.857。②LVO联合RT-3DE检测术后患者左心功能得到显著改善,左心功能指标差异均有统计学意义(均P<0.05)。③影响患者30 d生存率的独立危险因素包括:性别、Killips泵功能分级、是否外科手术。结论LVO与RT-3DE可提供更准确的VSR最大径、部位、数目及形状等解剖学信息,为治疗方案的选择提供依据。LVO联合RT-3DE评估手术前后左心功能的改变,可为临床评价预后提供参考。Objective To study the local morphology of post-infarction ventricular septal rupture(PI-VSR)and the left ventricular function before and after operation and to evaluate the relevant risk factors of death in patients with PI-VSR by using left ventricular opacification(LVO)combined with real-time three-dimensional echocardiography(RT-3DE).Methods Twenty-eight patients with PI-VSR and 19 patients undergoing surgical treatment were selected.The consistency of two-dimensional ultrasound,RT-3DE and the detection of LVO on the maximum diameter,location,number and shape of ventricular septal rupture(VSR)with the surgical results were compared.Through LVO combined with RT-3DE,the changes of left ventricular function indexes before and after surgery were compared.According to the general data and clinical data of patients,independent risk factors affecting survival and prognosis were explored.Results①There was no significant difference between LVO and RT-3DE in detecting VSR maximum diameter and surgical results(all P>0.05).The location,number and shape of VSR detected by LVO were consistent with the surgical results(all P<0.05).RT-3DE had good consistency in detecting VSR location,shape and surgical results(all P<0.05).Among them,of LVO′s detection of VSR location and shape and the Kappa values of consistence of the intraoperative results were 0.650 and 0.883 respectively.LVO had a sensitivity of 0.923,specificity of 1.000,accuracy of 0.947,positive predictive value of 1.000 and negative predictive value of 0.857 in observing VSR shape.②LVO combined with RT-3DE was used to evaluate the left ventricular function of postoperative patients.The parameters of left ventricular function improved significantly(all P<0.05).③The independent risk factors affecting the 30 d survival rate included:gender,Killips pump function classification,and whether or not surgery was performed.Conclusions LVO and RT-3DE can provide more accurate anatomical information such as VSR maximum diameter,location,number and shape,which provides t

关 键 词：超声心动描记术 实时三维 室间隔穿孔 左心声学造影 危险因素 

分 类 号：R54[医药卫生—心血管疾病]