左心室形态联合ST段压低对婴幼儿动脉导管未闭术后心功能不全的预测价值  

Role of left ventricular morphology combined with ST segment depression in prediction of postoperative cardiac dysfunction in infants with patent ductus arteriosus

作　　者：纪志娴[1] 罗刚[1] 王思宝 王葵亮 泮思林[1] JI Zhixian;LUO Gang;WANG Sibao;WANG Kuiliang;PAN Silin(Heart Center,Women and Children's Hospital,Qingdao University,Qingdao 266034,China)

机构地区：[1]青岛大学附属妇女儿童医院心脏中心,山东青岛266034

出　　处：《实用医学杂志》2023年第16期2057-2061,共5页The Journal of Practical Medicine

基　　金：国家自然科学基金项目(编号:82271725);泰山学者工程资助(编号:2018);青岛市科技惠民示范专项(编号:23-2-8-smjk-10-nsh)。

摘　　要：目的评估左心室形态联合ST段压低预测婴幼儿动脉导管未闭(PDA)术后心功能不全的临床价值。方法本研究设计为回顾性研究,将2016年1月至2022年12月青岛大学附属妇女儿童医院455例婴幼儿PDA实施手术关闭。记录术前心电图ST段压低及超声心动图指标:左心房内径(LAD)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、主动脉内径(AOD)、肺动脉内径(PAD)、肺动脉收缩压(PASP)、左心室射血分数(LVEF)及左心室短轴收缩率(LVFS)等临床资料。以术后左心功能不全进行分组比较,对可能影响心功能的因素进行二分类logistic回归分析,绘制ROC曲线分析左心室形态联合ST段压低的预测价值。结果本研究42例(9.23%)患儿术后出现左心功能不全,平均LVEF为(54.83±3.37)%。两组患儿年龄、体质量、BSA、PDA内径、LAD、AOD、PAD、LVEF、LVFS及PASP差异无统计学意义(P>0.05);左心功能不全患儿术前LVEDD、LVESD及ST段压低水平更高,差异有统计学意义(P<0.05)。多因素二分类logistic回归分析示ST段压低是预测PDA患儿术后发生心功能不全的独立危险因素(P<0.05),ROC分析曲线下面积为0.785,灵敏度为85.4%,特异度为54.0%。左心功能不全患儿术后6个月,LAD、LVEDD、LVESD、AOD及PAD较术前明显缩小(P<0.05),心电图ST段恢复正常。结论PDA不同术式闭合后均需警惕左心室收缩功能障碍,术前左心室形态联合ST段压低可作为预测PDA患儿术后心功能不全的重要指标。Objective To evaluate the role of left ventricular morphology combined with ST segment depression in predicting cardiac dysfunction in infants after patent ductus arteriosus(PDA).Methods This study is designed as a retrospective study.From January 2016 to December 2022,445 infants with PDA were treated in our hospital.Preoperative electrocardiogram examination and echocardiographic measurements were performed for recording the ST segment depression,left atrial diameter(LAD),left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),aortic diameter(AOD),pulmonary artery diameter(PAD),pulmonary artery systolic pressure(PASP),left ventricular ejection fraction(LVEF)and left ventricular fractional shortening(LVFS).According to the postoperative left ventricular function,the above indexes were divided into groups and compared.Binary logistic regression analysis was done to investigate potential influences on cardiac function,and a ROC curve was plotted to assess the predictive significance of combining left ventricular morphology with ST segment depression.Results The left ventricular dysfunction occurred in 42 cases(9.23%),with an average LVEF of(54.83±3.37)%.Compared with the children with normal LVEF,there was no significant difference in age,weight,BSA,PDA diameter,LAD,AOD,PAD,LVEF and PASP(P>0.05).The preoperative levels of LVEDD,LVESD and ST segment depression were significantly higher in the children with left ventricular dysfunction(P<0.05).Binary logistic regression analysis showed that ST depression was an independent risk factor for predicting post⁃operative cardiac insufficiency in the children with PDA.The area under the curve of ROC analysis was 0.785,the sensitivity was 85.4%,and the specificity was 54.0%.Compared with pre-operative conditions,the levels of LAD,LVEDD,LVESD,AOD,PAD and LVFS were significantly decreased 6 months after operation(P<0.05).Conclusion Attention should be paid to left ventricular systolic dysfunction after closure of different PDA proce⁃du

关 键 词：动脉导管未闭 左心功能不全 介入治疗 结扎术 心电图 儿童 

分 类 号：R543.5[医药卫生—心血管疾病]