室间隔缺损患儿术前超声心动图指标与手术预后的相关性研究  

Study on the correlation between preoperative echocardiography indicators and postoperative prognosis in children with ventricular septal defect

作　　者：周梦莹 俞劲[1] 段会龙[2] 舒强[1] 李建华[1] 叶菁菁[1] 李昊旻[1] Zhou Mengying;Yu Jin;Duan Huilong;Shu Qiang;Li Jianhua;Ye Jingjing;Li Haomin(Heart Center,Children′s Hospital,Zhejiang University School of Medicine,Hangzhou 310052,China;College of Biomedical Engineering and Instrument Science,Zhejiang University,Hangzhou 310027,China)

机构地区：[1]浙江大学医学院附属儿童医院心脏中心,杭州310052 [2]浙江大学生物医学工程与仪器科学学院,杭州310027

出　　处：《中华超声影像学杂志》2022年第9期767-773,共7页Chinese Journal of Ultrasonography

摘　　要：目的探讨室间隔缺损(VSD)术前超声心动图报告指标与手术预后的相关性并识别显著相关指标或指标比值进行验证。方法选择2016年6月至2021年6月于浙江大学医学院附属儿童医院进行手术矫治的VSD患儿1357例,提取术前超声心动图报告中的各种指标,包括VSD大小、左室射血分数(LVEF)、左房(LA)内径、主动脉(AO)流速、三尖瓣反流流速、三尖瓣反流压差等,分析超声心动图指标和指标比值与术后辅助通气时间的相关性。按有无术后并发症将患者分为有并发症组与无并发症组,比较两组间超声心动图指标的差异。基于以上指标建立线性回归模型,对术后辅助通气时长进行预测,采用最小绝对收缩与选择算子(LASSO)回归模型用于变量选择。结果单一指标VSD大小、AO流速与术后辅助通气时间存在较弱相关性(r=0.32、0.25,均P<0.01),VSD处流速与术后辅助通气时间无相关性。而指标比值AO流速/VSD处流速、LVEF/VSD处流速与术后辅助通气时间存在较强相关性(r=0.67、0.51,均P<0.01)。有并发症组与无并发症组三尖瓣反流流速、三尖瓣反流压差、LA内径、LVEF差异无统计学意义(均P>0.01);而计算比值后,并发症组LVEF/三尖瓣反流流速显著低于无并发症组,三尖瓣反流压差/LA内径显著高于无并发症组(均P<0.01)。在独立测试集上对VSD患者的术后通气时间进行预测,测试集决定系数(R2)达到0.51。结论术前超声心动图测量指标比值AO流速/VSD处流速、LVEF/VSD处流速与VSD患儿术后辅助通气时间有着较强相关性,LVEF/三尖瓣反流流速、三尖瓣反流压差/LA内径在有无术后并发症群体间的差异有统计学意义,同时指标组合可以显著提升其相关性和差异性,可应用于VSD手术预后的预测。Objective To explore the correlation between preoperative echocardiography indicators and surgical prognosis of children with ventricular septal defect(VSD)and conduct verification based on significant indicators and indicator ratios.Methods A total of 1357 children with VSD who were admitted to the Children′s Hospital,Zhejiang University School of Medicine from June 2016 to June 2021 were selected.Various measurements including the size of the VSD,left ventricular ejection fraction(LVEF),left atrial(LA)diameter,the aortic(AO)flow rate,the tricuspid regurgitation velocity and pressure gradient were extracted from preoperative echocardiography reports.This paper explored the correlation between echocardiography reports indicators,indicator ratios and postoperative auxiliary ventilation time,respectively.The patients were divided into two groups according to whether there were complications,and the differences of echocardiography reports indicators between the two groups were compared.A linear regression model was established to predict the postoperative auxiliary ventilation time using these indicators,and the least absolute shrinkage and selection operator(LASSO)regression model was used for variable selection.Results The VSD size and AO flow velocity were weakly correlated with the postoperative auxiliary ventilation time(r=0.32,0.25;all P<0.01).There was no significant correlation between VSD flow velocity and postoperative auxiliary ventilation time.The AO flow velocity/VSD flow velocity and LVEF/VSD flow velocity were strongly correlated with the postoperative auxiliary ventilation time(r=0.67,0.51;all P<0.01).In the significance test,there were no significant differences in tricuspid regurgitation flow velocity,tricuspid regurgitation pressure gradient,LA diameter,and LVEF between the complication group and the non-complication group(all P>0.01).However,the ratio of LVEF/tricuspid regurgitation velocity in the complication group was significantly lower than that in the non-complication group,and the ratio

关 键 词：超声心动描记术 室间隔缺损 手术预后 儿童 指标比值 

分 类 号：R726.5[医药卫生—儿科]