压力-应变环定量评价小儿法洛四联症手术后左心室收缩功能  

Left ventricular systolic function in children with repaired tetralogy of Fallot by pressure-strain loops

作　　者：黄仪 陶宏伟 陈伟玲 于薇 范舒旻[1] 王雷[1] 张青[2] 夏焙 Huang Yi;Tao Hongwei;Chen Weiling;Yu Wei;Fan Shumin;Wang Lei;Zhang Qing;Xia Bei(Department of Ultrasound,Shenzhen Children′s Hospital Affiliated to China Medical University,Shenzhen 518038,China;Department of Cardiac Surgery,Shenzhen Children′s Hospital Affiliated to China Medical University,Shenzhen 518038,China)

机构地区：[1]中国医科大学附属深圳市儿童医院超声科,深圳518038 [2]中国医科大学附属深圳市儿童医院心胸外科,深圳518038

出　　处：《中华超声影像学杂志》2022年第11期940-945,共6页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金面上项目(62071309);深圳市科技计划项目(SGDX20201103095802007)。

摘　　要：目的:应用压力-应变环(PSL)技术定量检测法洛四联症(TOF)患儿术后左室心肌做功,评价TOF术后患儿左室收缩功能的变化。方法:回顾性分析2015年9月至2021年9月深圳市儿童医院的76例TOF矫治术后患儿,术后≤4年组41例,术后>4年组35例。选取同期与TOF患儿体表面积匹配的76例健康儿童作为对照组。全部受检者均进行完整超声心动图检查并进行左室心肌做功定量分析,包括整体纵向应变(GLS)、整体做功指数(GWI)、整体有效功(GCW)、整体无用功(GWW)以及整体做功效率(GWE)。与健康儿童相比,分析TOF患儿术后左室心肌的做功情况;对手术前后超声心动图资料均完整者,分析术后左室心肌做功参数与术前右室流出道(RVOT)内径及Z值的相关性。随机抽取TOF术后患儿及健康儿童20例重复进行左室心肌做功的定量分析,检验PSL技术的重复性。结果:①术后≤4年组GLS、GWI、GCW、GWE低于对照组,而GWW高于对照组,差异有统计学意义[(-20.00±1.52)%比(-21.59±1.73)%、(1349.37±133.63)mmHg%比(1553.51±246.09)mmHg%、(1589.39±167.85)mmHg%比(1749.12±249.45)mmHg%、94.0%(94.0%,95.0%)比96.0%(95.0%,97.0%)、(78.80±20.53)mmHg%比(62.27±21.44)mmHg%,均P<0.05]。②术后>4年组GLS、GWI、GWE低于对照组,而GWW高于对照组,差异有统计学意义[(-19.89±1.66)%比(-21.31±1.60)%、(1486.09±172.42)mmHg%比(1713.14±227.05)mmHg%、96.0%(94.0%,96.0%)比97.0%(96.0%,97.0%)、75.00(62.00,95.00)mmHg%比55.00(42.00,71.00)mmHg%,均P<0.05]。③术后患儿GWW与术前RVOT内径、RVOT-Z值呈负相关(r=-0.422、-0.433,均P<0.05);GWE与术前RVOT内径、RVOT-Z值呈正相关(r=0.441、0.540,均P<0.05)。④GLS、GWI、GCW、GWW、GWE观察者内及观察者间重复性良好,差异无统计学意义(均P>0.05)。结论:TOF患儿手术后左室功能仍低于同龄健康儿童,表现为左室长轴应变和有效做功减低,尽管这些患儿的传统收缩功能指标仍在正常范围内。TOF术前RVOT梗阻�Objective To quantify the left ventricular myocardial work in patients with repaired tetralogy of Fallot(TOF),and to evaluate the changes in left ventricular systolic function after TOF repair by pressure-strain loops(PSL).Methods Seventy-six cases of children after TOF complete surgery in Shenzhen Children′s Hospital from September 2015 to September 2021 were analyzed retrospectively.There were 41 cases in the≤4-year group and 35 cases in the>4-year group.Seventy-six healthy children with matched body surface area in the same period were selected as the control group.All subjects underwent complete echocardiography and quantitative analysis of left ventricular myocardial work,including global longitudinal strain(GLS),global work index(GWI),global constructive work(GCW),global wasted work(GWW),and global work efficiency(GWE).Compared with the normal control group,the changes of left ventricular myocardial work after TOF repair were analyzed.For patients with complete echocardiographic data before and after surgery,the correlation between postoperative left ventricular myocardial work and preoperative degree of right ventricular outflow tract(RVOT)obstruction was analyzed.Results①In the≤4-year group,compared with control subjects,GLS,GWI,GCW,GWE decreased,and GWW increased in patients with repaired TOF.All the differences were statistically significant[(-20.00±1.52)%vs(-21.59±1.73)%,(1349.37±133.63)mmHg%vs(1553.51±246.09)mmHg%,(1589.39±167.85)mmHg%vs(1749.12±249.45)mmHg%,94.0%(94.0%,95.0%)vs 96.0%(95.0%,97.0%),(78.80±20.53)mmHg%vs(62.27±21.44)mmHg%;all P<0.05].②In>4-year group,compared with the control group,GLS,GWI,GWE decreased,and GWW increased in patients with repaired TOF.All the differences were statistically significant[(-19.89±1.66)%vs(-21.31±1.60)%,(1486.09±172.42)mmHg%vs(1713.14±227.05)mmHg%,96.0%(94.0%,96.0%)vs 97.0%(96.0%,97.0%),75.00(65.00,95.00)mmHg%vs 55.00(42.00,71.00)mmHg%;all P<0.05].③GWW was negatively correlated with preoperative RVOT diameter and RVOT-Z score(r=-0.422,-

关 键 词：超声心动描记术 压力-应变环 法洛四联症 儿童 

分 类 号：R445.1[医药卫生—影像医学与核医学] R726.5[医药卫生—诊断学]