婴幼儿法洛四联症根治术后肺动脉瓣反流的预测分析  

Predictive of post-operative pulmonary regurgitation in infants Tetralogy of Fallot

作　　者：李晓雪 杨一妃 梁永梅[1] 王志远[1] 吕震宇[1] 顾燕[1] 金梅[1] LI Xiaoxue;YANG Yifei;LIANG Yongmei;WANG Zhiyuan;LV Zhenyu;GU Yan;JIN Mei(Department of Pediatric Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所小儿心脏中心,100029

出　　处：《心肺血管病杂志》2024年第7期731-735,753,共6页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:了解肺动脉参数对婴幼儿法洛四联症根治术后出现肺动脉瓣反流的预测效能。方法:回顾性分析2014年1月至2018年12月,就诊于首都医科大学附属北京安贞医院,确诊为法洛四联症,行一期根治术的婴幼儿患者的临床资料。根据手术方式分为行跨环手术组与非跨环手术组。根据随访期间内有无新出现肺动脉瓣反流分为反流组与非反流组,对入组患儿的临床基本资料、术前肺动脉参数资料、手术方式及资料进行分析,比较两组间差异。绘制受试者工作曲线并计算曲线下面积,评估相关指标的预测效果。结果:共纳入124例患儿。其中男性72例,女性52例;平均患儿手术年龄(11.9±6.4)个月。术后平均随访时间为61.9个月。124例行一期根治术的患儿中,新出现肺动脉瓣反流111例(89.5%),其中24例(19.4%)为中度至重度肺动脉瓣反流。手术方式与术后发生中重度PR相关。术后PR与MaGoon比值、肺动脉瓣瓣环Z值、行TAP手术、主动脉阻断时间及体外循环时间有关。行ROC曲线分析显示肺动脉瓣瓣环Z值曲线下面积(AUC)为0.724。同时PAAI(AUC=0.659)对术后肺动脉瓣反流也具有一定的预测价值,且预测效果与PV z-score大致相当。结论:婴幼儿法洛四联症根治术术前的肺动脉瓣环Z值可以较好地预测术后肺动脉瓣反流的发生。Objective:To assess the predictive value of pulmonary artery parameters for the occurrence of pulmonary regurgitation(PR)after corrective surgery in infants with tetralogy of Fallot(TOF).Methods:A retrospective analysis was conducted on clinical data of infants diagnosed with TOF who underwent primary corrective surgery at Beijing Anzhen Hospital,Capital Medical University,from January 2014 to December 2018.The patients were divided into groups based on whether they underwent transannular patch(TAP)surgery or non-TAP patch surgery.Another classification was based on the presence of PR during the follow-up period,resulting in the PR group and non-PR group.Clinical basic information,preoperative pulmonary artery parameters,and surgical procedures of the included patients were analyzed to compare differences between the two groups.The receiver operating characteristic(ROC)curve was constructed,and the area under the curve was calculated to assess the predictive performance.Results:A total of 124 pediatric patients were included.Among them,there were 72 males and 52 females;the average age of surgery for the patients was(11.9±6.4)months.The average follow-up time after surgery was 61.94 months.Among 124 infants who underwent primary corrective surgery,PR occurred in 111 cases(89.5%),with 24 cases(19.4%)showing moderate to severe PR.The surgical approach was associated with the occurrence of moderate to severe PR postoperatively.Postoperative PR was related to MaGoon ratio,Pulmonary Annulus z-score(PV z-score),undergoing TAP procedure,aortic cross-clamp time,and cardiopulmonary bypass time.The ROC curve analysis showed that the AUC for PV z-score were 0.724.Additionally,the Pulmonary Artery Acceleration Index(PAAI,AUC=0.659)also predicted postoperative PR to a certain extent,with a predictive effect similar to PV z-score.Conclusions:The preoperative PV z-score in infants undergoing corrective surgery for TOF can predict the occurrence of postoperative PR effectively.

关 键 词：法洛四联症 术后并发症 肺动脉瓣反流 肺动脉瓣环Z值 跨环手术 

分 类 号：R54[医药卫生—心血管疾病]