| 摘要: |
| 目的 探讨完全型肺静脉异位（TAPVC）的超声诊断特点及梗阻性与非梗阻性TAPVC在手术前后的异同。方法 选取TAPVC患儿112例，分为梗阻组34例及非梗阻组78例。分别于术前、术后一个月及六个月进行超声心动图检查，评价心内结构、功能及肺静脉引流情况。应用M型超声测量左、右心室舒张末期内径（LVD, RVD），脉冲多普勒测量肺静脉流速，连续多普勒测量三尖瓣反流峰值压差（PTR）。分析并比较同一患儿术前术后以及两组患儿间心室内径及PTR的变化，以及两组间死亡率及术后肺静脉梗阻（PVO）发生率。 结果 超声心动图对TAPVC的诊断率为100%，准确率为89%。梗阻组较非梗阻组手术月龄及体重低，差异具有统计学意义（P值均<0.001）。术后一个月两组患儿LVD及LVD/RVD均明显增大，RVD及PTR明显减小，差异均有统计学意义（P值均<0.01）。术后一月及六个月两组患儿PTR及LVD/RVD均没有统计学上的差异 （P值均>0.05）。术后死亡率梗阻组较高，差异具有统计学意义（11.8% vs 0%，P<0.01）。术后PVO发生率在两组间没有统计学差异（P>0.05）。结论 超声心动图是TAPVC早期诊断的有效方法，且可对分型、肺动脉压力及梗阻性TAPVC的梗阻部位及程度进行较为准确的评估。梗阻性患儿更需要早期诊断及时治疗，两组患儿在外科矫治后均可获得较为满意的预后，梗阻性患儿死亡率相对较高，而术后PVO发生率没有明显差异。 |
| 关键词: 超声心动图 完全型肺静脉异位引流 肺静脉梗阻 |
| DOI： |
| 投稿时间：2016-12-09修订日期：2016-12-09 |
| 基金项目: |
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| The evaluation of obstructed and non-obstructed total anomalous pulmonary venous connection by echocardiography |
| LI Muzi,PANG Kunjing |
| (Chinese Academy of Medical Sciences Fu Wai Hospital) |
| Abstract: |
| Objective To describe the ultrasonic image features of TAPVC and compare the differences between obstructed and non-obstructed TAPVC before and after surgery. Methods A total of 112 TAPVC patients were assessed, including77 boys and 35 girl. The patients were divided into two groups, 34 obstructed patients and 78 non-obstructed patients. The echo were performed before operation, 1month and 6 months after operation to evaluate the heart structure and function and the anomalous pulmonary venous．The left and right ventricular end diastolic diameter (LVD&RVD) were measured with M-mode ultrasound. The tricuspid valve regurgitation maximum pressure gradient（PTR） and the flow velocity of pulmonary vein were respectively measured with and pulsed-wave and continuous Doppler.Test the ventricular diameter and PTR before and after surgery and the comparison between groups. The mortality and incidence of pulmonary venous obstruction (PVO) was analyzed. Results The rate of TAPVC diagnosis by echocardiography was 100% and 89% of accuracy. The month age and weight at surgery of obstructed group were lower than non-obstructed group (P <0.001). One month after surgery, LVD and LVD/RVD of all two groups patients were lager than before operation，RVD and PRT was lower (P<0.01). There were no statistically significant difference between the two groups of PTR and LVD/RVD one month and six month after surgery (P >0.05). The mortality of obstructed group was higher (11.8% vs 0%，P<0.01).The incidence of pulmonary venous obstruction after surgery has no significant statistical difference (17.6% vs 6.4%，P>0.05). Conclusions Echocardiography is valuable in the diagnosis of TAPVC, with acute assessment of classification, pulmonary pressure, the degree and position of pulmonary venous obstruction. Baby with obstructed TAPVC need early diagnosis and timely treatment. However prognosis of both groups’ patients was good. What’s more, the incidence of pulmonary venous obstruction after surgery has no significant statistical difference between groups. |
| Key words: 超声心动图 完全型肺静脉异位引流 肺静脉梗阻 |
