三维超声估测左心室舒张末期容积指数对法洛四联症手术的指导价值

Value of three-dimensional echocardiography in estimating left ventricular end-diastolic volume index for guiding radical surgery of tetralogy of Fallot

目的 探讨三维超声（3DE）估测左心室舒张末期容积指数（LVEDVI）对法洛四联症（TOF）根治手术预后的指导价值.方法 采用传统的M型和二维心尖四腔观单平面、双平面Simpson法与3DE测量方法分别估测38例TOF患者的LVEDVI并进行差异性研究.以经验值LVEDVI＜24 ml/m2及LVEDVI＜20 ml/m2为手术禁忌,对四种方法预测手术禁忌病例的敏感性及特异性进行统计学比较.结果 传统的M型法、单平面Simpson法LVEDVI测值与3DE测值差异均有统计学意义（P＜0.05）,双平面Simpson法LVEDVI测值与3DE测值差异无统计学意义.以两种经验值为禁忌分组预测因左室容积过小引起严重的低心排血量综合征导致死亡病例的敏感性及特异性结果：M型法预测的敏感性最低,与其他测量法差异无统计学意义（P＞0.05）;单平面Simpson法预测的特异性最低,与其他三种方法比较差异有统计学意义（P＜0.05）.结论 3DE估测法可为判断法洛四联症根治手术预后提供可靠依据.

Objective To explore the value of three-dimensional echocardiography （3DE） in estimating left ventricular end-diastolic volume index （LVEDVI） in the prognosis of radical surgery of tetralogy of Fallot（TOF）. Methods The LVEDVI of 38 TOF cases were estimated respectively by the method of M-Mode, single plane Simpson, bi-plane Simpson and 3DE. Then the difference of sensitivity and specificity in predicting death cases for severe low cardiac output syndrome were explored between four methods in estimating LVEDVI by taking LVEDVI＜24 ml/m2 or LVEDVI＜20 ml/m2 as contraindications of radical surgery of TOF. Results The measurements of LVEDVI in the method of 3DE had significant difference with those in M-Mode and single plane Simpson method （ P ＜ 0.05＝. The measurements of LVEDVI in the method of 3DE had not significant difference with those in bi- plane Simpson method （ P ＞0.05）. To take the above two experience value as contraindication to group cases, the results were consistent：the predicting sensitivity of M-Mode in estimating LVEDVI was lowest and the difference with that of other three methods were not significant, the predicing specificity of single plane Simpson in estimating LVEDVI was lowest and the difference with that of the other three methods were significant （P ＜ 0.05＝. Conclusions 3DE can provide a reliable basis in the prognosis of radical surgery of TOF.