单心室患儿心室功能变化及实时三维超声心动图的应用价值分析

Changes of Ventricular Function of Children with Single Ventricle and Evaluation Value of Real-time Three-dimensional Echocardiography

目的分析单心室患儿心室功能变化及实时三维超声心动图(RT-3DE)的应用价值。方法选择中南大学湘雅二医院2012年1月—2013年6月收治的单心室患儿35例为观察组,同期收治的非心脏疾病患儿30例作为对照组。对两组患儿进行RT-3DE检查,比较两组患儿心室功能指标,包括舒张末容积(EDV)、收缩末容积(ESV)、左心室射血分数(LVEF)、最大射血速率(PER)/EDV,左心室16节段达最低收缩末容量时间最大标准差(Tmsv16-Dif)及其占心动周期的百分比(Tmsv16-Dif%)、左心室16节段达最低收缩末容量时间最小标准差(Tmsv16-SD)及其占心动周期的百分比(Tmsv16-SD%)、主心腔残腔侧和非残腔侧各节段(基底段、中间段、心尖段)收缩位移值。结果观察组患儿EDV、ESV大于对照组,Tmsv16-Dif、Tmsv16-SD、Tmsv16-Dif%、Tmsv16-SD%长于对照组,LVEF、PER/EDV小于对照组,主心腔残腔侧基底段、中间段、心尖段收缩位移值短于对照组(P<0.05);两组患儿主心腔非残腔侧基底段、中间段、心尖段收缩位移值比较,差异均无统计学意义(P>0.05)。不同性别单心室患儿Tmsv16-Dif、Tmsv16-SD、Tmsv16-Dif%、Tmsv16-SD%比较,差异均无统计学意义(P>0.05)。结论单心室患儿存在功能性心室重构及心室壁运动不同步,心室收缩功能和射血功能明显下降,室壁运动功能较差,RT-3DE可有效评估单心室患儿心室功能。

Objective To investigate the changes of ventricular function of children with single ventricle and evaluation value of real-time three-dimensional echocardiography（RT-3DE）. Methods From January 2012 to June 2013 in the Xiangya No. 2 Hospital of Central South University,35 children with single ventricle were selected as observation group, 30 children without heart diseases were selected as control group. Children of both groups received RT-3DE examination,and ventricular function indicators including EDV,ESV,LVEF,PER/EDV,Tmsv16-Dif and Tmsv16-Dif%,Tmsv16-SD and Tmsv16-SD%,contraction displacement of residual cavity and normal cavity of ventricle（ including basal segment,middle segment,apical segment ） were compared between the two groups. Results EDV and ESV of observation group were statistically significantly larger than those of control group,Tmsv16-Dif and Tmsv16-Dif%,Tmsv16-SD and Tmsv16-SD%of observation group were statistically significantly longer than those of control group,LVEF and PER/EDV of observation group were statistically significantly less than those of control group, contraction displacement of basal segment, middle segment, apical segment of residual cavity of ventricle were statistically significantly shorter than those of control group（P﹤0. 05）,but no statistically significant differences of contraction displacement of basal segment,middle segment,apical segment of normal cavity of ventricle were found between the two groups（P﹥0. 05）. Conclusion Functional ventricular remodeling and unsynchronized ventricular wall motion are commonly existed in children with single ventricle,the ventricular systolic function and eject function are decreased,with poor ventricular wall motion function,and RT-3DE can effectively evaluated the ventricular function.