基于多层感知器评价房间隔缺损封堵术中右上肺静脉鞘管压迫法超声测量的准确性  

Evaluation of the accuracy of the right superior pulmonary vein sheath compression in the closure of atrial septal defect based on multi-layer perceptron by ultrasound

作　　者：周洁丽 韩冬[2] 刘丽文 司瑞 李寰 张诗倩 胡运 Zhou Jieli;Han Dong;Liu Liwen;Si Rui;Li Huan;Zhang Shiqian;Hu Yun(Department of Ultrasound,the First Hospital Affiliated of Air Force Medical University,Xi′an 710032,China;Department of Radiology,the Affiliated Hospital of Shaanxi University of Chinese Medicine,Xianyang 712000,China;Department of Cardiology,the First Hospital Affiliated of Air Force Medical University,Xi′an 710032,China)

机构地区：[1]空军军医大学第一附属医院超声医学科,西安710032 [2]陕西中医药大学第一附属医院影像科,咸阳712000 [3]空军军医大学第一附属医院心脏内科,西安710032

出　　处：《中华超声影像学杂志》2020年第5期384-388,共5页Chinese Journal of Ultrasonography

摘　　要：目的:采用多层感知器评价经胸超声对"术中右上肺静脉鞘管压迫"测量房间隔缺损(ASD)压管值对选择封堵器的准确性。方法:回顾性分析2016年1月至2019年1月在空军军医大学第一附属医院成功进行封堵治疗的残缘为软缘、发育菲薄或合并房间隔瘤的中央型ASD患者460例,年龄(34.32±18.84)岁,男性129例,女性331例。记录术前经胸超声心动图(TTE)测量的ASD大小,以及术中TTE测量经右上肺静脉鞘管压迫后所得的ASD压管值大小。以手术最终选择的封堵器大小作为因变量,分别将术前和术中超声测量值作为协变量。将所有患者按照5∶2∶3比例随机分为训练集、测试集及验证集导入多层感知器,采用梯度下降法优化调整权重,分别进行10次运算,计算相对误差平均值,评价两种超声测量方法对封堵器选择的准确性。结果:所有患者术前超声测量的ASD大小为(15.26±5.33)mm,术中压管值为(23.83±6.39)mm,术后封堵器大小为(25.14±6.55)mm。术前、术后及封堵器大小依次递增,差异有统计学意义(χ2=850.450,P<0.001),两两比较差异均有统计学意义(P<0.001)。运行10次多层感知器,获得基于术前TTE和术中右上肺静脉鞘管压迫后TTE测量的ASD压管值预测封堵器大小的训练模型。其中采用术前TTE获得的模型在验证集的相对误差为(16.55±0.02)%,术中右上肺静脉鞘管压迫后TTE测量的ASD压管值获得的模型在验证集的相对误差为(4.81±0.01)%,两种测量方法的误差差异有统计学意义(t=16.185,P<0.001)。结论:ASD封堵术中使用右上肺静脉鞘管压迫法、经胸超声测量ASD压管值的大小,对ASD封堵器的选择更加准确。对于ASD后缘、下缘、后下缘残缘为软缘,且发育菲薄或合并房间隔瘤的ASD患者封堵器的精确选择有重要指导作用。Objective To evaluate the accuracy of measuring the siae of atrial septal defect(ASD)by transthoracic echocardiography(TTE)on"compression of right superior pulmonary vein sheath during operation"(compression-size)using multi-layer perceptron.Methods From January 2016 to January 2019,460 cases of ASD with soft margin,thin growth or central type with atrial septal tumor in the First Hospital Affiliated of Air Force Medical University were analyzed retrospectively.The age was(34.32±18.84)years,129 males and 331 females.Preoperative TTE and intraoperative TTE were performed to measure the size of ASD and compression-size.With the final occluder size selected as the dependent variable,the preoperative and intraoperative ultrasound measurements were used as covariates,and all patients were randomly divided into training set,test set and verification set according to the proportion of 5∶2∶3,which were imported into multi-layer perceptron.Gradient descent method was used to optimize and adjust the weight,and 10 operations were carried out respectively,and the average value was calculated to evaluate the two ultrasound methods for blocking.Results The mean values of ASD were(15.26±5.33)mm for preoperative,(23.83±6.39)mm for compression-size intraoperative TTE,and(25.14±6.55)mm for the occluder,respectively.The difference was statistically significant(χ^2=850.450,P<0.001).There were significant differences between the pairwise(P<0.001).Ten times of multi-layer perceptron were used to obtain a training model for predicting the size of the occluder based on preoperative transthoracic ultrasound and TTE measurement after right upper pulmonary vein sheath compression.The average relative error of the model obtained by preoperative ultrasound measurement in the validation set was(16.55±0.02)%,and that of the model obtained by intraoperative ultrasound measurement in the validation set was(4.81±0.01)%.The difference between the two methods was statistically significant(t=16.185,P<0.001).Conclusions It is more accurate

关 键 词：超声检查 多层感知器 房间隔缺损 右上肺静脉鞘管压迫法 封堵器 

分 类 号：R654.2[医药卫生—外科学]