延迟就诊室间隔完整完全性大动脉转位患儿术前评估左心室退化研究  

Preoperative assessment of left ventricular degeneration in late presenters with dextro-transposition of great arteries with intact ventricular septum

作　　者：孙阳雪 顾沅芮 段亚冰 董硕 张雅娟[1] 闫军[1] SUN Yang-xue;GU Yuan-rui;DUAN Ya-bing;DONG Shuo;ZHANG Ya-juan;YAN Jun(Department of Pediatric Cardiac Surgery,Fu-wai Hospital,National Center for Cardiovascular Disease,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院小儿心脏外科,北京100037

出　　处：《临床军医杂志》2021年第5期524-527,共4页Clinical Journal of Medical Officers

基　　金：中国医学科学院医学与健康科技创新工程2020年临床与转化医学研究基金项目(2020-12M-C&T-B-060)。

摘　　要：目的探讨延迟就诊室间隔完整的完全性大动脉转位(dTGA-IVS)患儿左心室退化的影响因素。方法选取中国医学科学院阜外医院自2007年1月至2019年1月收治的76例首次手术年龄>28 d的dTGA-IVS患儿为研究对象。根据选择的不同手术治疗策略将其分为一期大动脉调转术组(A组)与双期大动脉调转术组(B组),每组各38例。记录并比较两组患儿的一般资料,包括接受第1次手术年龄、体质量、性别比例及术前超声心动图相关数据(左室舒张末径、左室后壁厚度、房间隔缺损有效分流直径、是否合并动脉导管未闭)。患儿于首次接受手术治疗前进行超声心动图检测。采用Pearson相关性分析检验左心室收缩压/右心室收缩压与各临床指标的相关性。采用线性回归模型分析左心室收缩压/右心室收缩压的影响因素。结果 A组患儿接受第1次手术年龄、体质量、房间隔缺损有效分流直径均小于B组,左心室收缩压/右心室收缩压显著高于B组,差异均有统计学意义(P<0.05)。Pearson相关性分析显示,年龄、体质量、房间隔缺损有效分流直径与左心室收缩压/右心室收缩压呈负相关(P<0.05)。结论对于延迟就诊的dTGA-IVS患儿,详尽的术前评估对于手术策略的选择具有重要意义。年龄、体质量及房间隔缺损有效分流直径与dTGA-IVS患儿左心室的功能状态密切相关。Objective To investigate the influencing factors of left ventricular degeneration in children with delayed complete transposition of the great arteries(DTGA-IVS).Methods A total of 76 DTGA-IVS children with >28 days of age at first operation were selected from Fuwai Hospital of Chinese Academy of Medical Sciences from January 2007 to January 2019.According to the different surgical treatment strategies, the patients were divided into two groups: group A and group B,with 38 patients in each group.General data of the two groups were recorded and compared, including age, body weight, gender, and preoperative echocardiographic data(left ventricular end-diastolic diameter, left ventricular posterior wall thickness, effective shunt-diameter of atrial septal defect, and patent ductus arteriosus).Echocardiography was performed before the first surgical treatment.Pearson correlation analysis was used to test the correlation between left ventricular systolic blood pressure/right ventricular systolic blood pressure and all clinical indicators.The influencing factors of left ventricular systolic pressure/right ventricular systolic pressure were analyzed by linear regression model.Results The age after the first operation, body weight and effective shunt diameter of atrial septal defect in group A were all lower than that in group B,and LVSP/RVSP was significantly higher than that in group B,with statistical significance(P<0.05).Pearson correlation analysis showed that age, body weight and effective shunt diameter of atrial septal defect were negatively correlated with left ventricular systolic blood pressure/right ventricular systolic blood pressure(P<0.05).Conclusion For children with advanced DTGA-IVS,detailed preoperative evaluation is of great significance for the selection of surgical strategy.Age, body weight and effective shunt diameter of atrial septal defect were closely related to the functional status of left ventricle in children with DTGA-IVS.

关 键 词：室间隔完整的完全性大动脉转位 大动脉调转术 延迟就诊 超声心动图 

分 类 号：R54[医药卫生—心血管疾病]