超声心动图评估常见左向右分流型先天性心脏病介入治疗左心室舒张功能改善的自身前后对照试验  

Echocardiographic evaluation of left ventricular diastolic function improvement after interventional therapy in common left-to-right shunt congenital heart diseases:A self-controlled before-after trial

作　　者：袁龙宇 黄智林 罗静 孙慧超[1] 刘玲娟[1] 袁宇星 田杰[1] YUAN Longyu;HUANG Zhilin;LUO Jing;SUN Huichao;LIU Lingjuan;YUAN Yuxing;TIAN Jie(Department of Cardiovascular Medicine,Children's Hospital of Chongqing Medical University,Ministry of Education Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders,China International Science and Technology Cooperation base of Child development and Critical Disorders,Children's Hospital of Chongqing Medical University,Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院心血管内科,儿童发育疾病研究教育部重点实验室,国家儿童健康与疾病临床医学研究中心,儿童发育重大疾病国家国际科技合作基地,儿科学重庆市重点实验室,重庆400014

出　　处：《中国循证儿科杂志》2023年第3期199-203,共5页Chinese Journal of Evidence Based Pediatrics

摘　　要：背景心功能异常时舒张功能通常首先有改变,目前虽有很多关于心室收缩功能研究,但却鲜有关于先天性心脏病(CHD)左心室舒张功能变化的研究。目的通过超声心动图评估常见左向右分流型CHD介入治疗前后左心室舒张功能指标。设计自身前后对照试验。方法纳入在重庆医科大学附属儿童医院诊断为动脉导管未闭(PDA)、室间隔缺损(VSD)、房间隔缺损(ASD)的年龄<18岁并行介入治疗的CHD患儿,排除复杂CHD、先天性发育异常、遗传代谢性疾病的患儿为病例组,同时招募健康儿童。行剑突下、胸骨旁、胸骨上窝等部位多切面超声扫查,采集病例组和健康儿童的左心室舒张功能指标(左心室结构、二尖瓣口血流频谱、二尖瓣环组织多普勒运动频谱和肺静脉血流频谱指标)及一般信息(超声检查时的年龄、身高、体重、体表面积)。基于健康儿童的左心功能指标,分析比较病例组介入手术前1周内、术后1 d、术后1个月时点的左心功能指标变化。主要结局指标介入术后左心房容积指数(LAI)、二尖瓣舒张早期血流峰值流速(E)/二尖瓣舒张晚期血流峰值流速(A)比值、E/二尖瓣环室间隔处舒张早期运动峰值流速(E')比值、E/二尖瓣环侧壁处舒张早期运动峰值流速(e')比值恢复水平。结果病例组163例,PDA亚组60例、VSD亚组42例、ASD亚组61例;招募健康儿童61例。PDA、VSD亚组年龄、身高、体重、BSA均低于对照组,差异均有统计学意义。PDA、VSD和ASD亚组,LAI、E/A比值、E/e'比值和E/E'比值,术前均高于对照组,差异有统计学意义,术后1 d下降,术后1个月恢复至对照组水平。肺静脉血流频谱D术前、术后1 d和术后1个月均呈降低趋势,术后1个月较对照组降低。结论超声心动图可作为儿童常见左向右分流型CHD左心室舒张功能的评估手段,PDA、VSD和ASD均存在不同程度的左心室舒张功能障碍,介入治疗后舒张功�Background Changes in diastolic function are usually the first to occur when there is abnormal cardiac function.Currently,although there are many studies on ventricular systolic function,there is limited research on the changes in left ventricular diastolic function in congenital heart disease(CHD).ObjectiveTo assess left ventricular diastolic function indices of CHD with left-to-right shunt before and after interventional therapy using echocardiography.DesignSelf-controlled before-after trial.MethodsThe case group of this study included pediatric patients under 18 years old who were diagnosed with patent ductus arteriosus(PDA),ventricular septal defect(VSD),or atrial septal defect(ASD)and underwent interventional treatment at the Children's Hospital of Chongqing Medical University.Patients with complex CHD,congenital developmental abnormalities,or genetic metabolic diseases were excluded from the study.Healthy children were recruited as the control group.Multiple-sectional echocardiographic scans were performed on the lower sternal border,parasternal area,and suprasternal area to collect left ventricular diastolic function parameters(including left ventricular structure,blood flow spectrum for mitral valve and pulmonary veins,and tissue Doppler motion spectrum for mitral annular)as well as general information(age,height,weight,body surface area)during the ultrasound examination.Left ventricular function parameters in the case group were compared within 1 week before intervention surgery,1 day after the surgery,and 1 month after the surgery to analyze the changes by taking the parameters of healthy children as the reference.Main outcome measuresRecovery levels of left atrial volume index(LAVI),early diastolic mitral flow peak velocity(E)/late diastolic mitral flow peak velocity(A)ratio,E/early diastolic mitral annular peak velocity at ventricular septum(E')ratio,and E/early diastolic mitral annular peak velocity at lateral wall(e')ratio after interventional therapy.ResultsA total of 163 cases of CHD patients were

关 键 词：超声心动图 先天性心脏病 动脉导管未闭 室间隔缺损 房间隔缺损 左心室舒张功能 

分 类 号：R540.45[医药卫生—心血管疾病] R541.1[医药卫生—内科学]