超声心动图在球囊肺动脉瓣成型术的应用探讨

Evaluation of echocardiography in balloonvuloplasty for pulmonary stenosis

目的 探讨超声心动图（ＥＣＨＯ） 在球囊肺动脉瓣成型术（ＰＢＰＶ） 中的应用。方法 收集从１９９５ 年１ 月至１９９８ 年７ 月共９０ 例肺动脉瓣狭窄（ＰＳ）的患儿，其中男６１ 例，女２９ 例，年龄１～１４ 岁，平均（６－３±３－９）岁，体重９ ～４５ ｋｇ，平均（２０－５±１５－８） ｋｇ，１８ 例合并卵圆孔未闭，１２ 例合并右室流出道狭窄。ＰＢＰＶ 术前后均作ＥＣＨＯ 及心导管检查，测量肺动脉瓣环（ＰＶＡＤ），肺动脉瓣（ＰＶ） 开放口径，ＰＶ 最大血流速度Ｖｍａｘ 及压力阶差ΔＰ，右室流出道（ＲＶＯＴ） 血流速度，并作对照分析。结果 ＰＢＰＶ术前ＥＣＨＯ与心导管检查所测ＰＶＡＤ、ＰＶ开放口径、ＰＶΔＰ无显著性差异（ Ｐ＞０－０５） ，ｔ＝ ２－５６，显示有密切相关；ＰＢＰＶ 术前后心导管及ＥＣＨＯ 所测ＰＶ 开放口径、ＰＶΔＰ均有显著性差异（Ｐ＜０－０１）。术后２４ 小时ＥＣＨＯ检查，有１９ 例ＲＶＯＴ血流增快，经服β－ 受体阻滞剂（ 心得安１～２ ｍｇ·ｋｇ１·ｄ１） ，３～６ 月后恢复正常。结论 超声心动图为ＰＢＰＶ术前选择球囊及扩张方法提供可靠资料，并能评价ＰＢＰＶ的扩张效果及长期随访，且对是否服用β－ 受体阻滞剂提供依据。

Objective For the purpose of evaluating the value of echocardiography (ECHO) in balloonvuloplasty of pulmonary stenosis (PS). Methods Before and after the operation, ECHO and cardiac catheterization were done. The annular diameter, bore, maximum flow and gradient of pulmonary artery (PA) and the flow velocity of right ventricular outlet tract (RVOT) were measured. Results Both the examination showed no different ( P>0.05 ), but the bores and gradient of PA obtained before and after the operation were of significant difference ( P<0.01 ). 24 hours after the operation, ECHO showed quicker flow from RVOT, but it recovered through taking β-blockers (Inderal 1～2 mg·kg 1 ·d 1 ) in 19 cases.Conclusions ECHO is safe to selection of balloon and expansive method, while it can be used for evaluation of the efficiency of the operation.