超声心动图监测下介入封堵术对先天性心脏病患者右心功能的影响

Study on the Effect of Echocardiography Monitored Transcatheter Closure on Right Ventricular Function in Patients with Congenital Heart Disease

目的:探讨超声心动图下介入封堵术对先天性心脏病(CHD)患者右心功能的影响。方法:分析行超声心动图监测下介入封堵术的42例CHD患者(CHD组,n=42)和40例健康体检者(对照组,n=40)临床资料,比较两组受试者左心功能指标[左室射血分数(LVEF)、左室舒张末期前后径(LVEDD)、左室收缩末期前后径(LVESD)]、右心功能指标[右室舒张末/收缩末容积、右心室舒张期射血分数(RVEF)]、炎症细胞因子[白细胞介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)]、血浆心钠肽(ANP)水平差异。结果:对照组LVEDD、LVESD等左心功能指标、右室舒张末容积、右室收缩末容积等右心功能指标,IL-6、CRP、TNF-α等炎症细胞因子水平及血浆ANP水平均显著低于CHD组各时段检测结果,LVEF、RVEF水平则显著高于CHD组,差异均有统计学意义(P<0.05);术后1、3个月时,CHD组LVEDD、LVESD水平,右室舒张末容积、右室收缩末容积等右心功能指标,IL-6、CRP、TNF-α等炎症细胞因子水平及血浆ANP水平均较术前显著降低,LVEF、RVEF水平则较术前显著升高,差异均有统计学意义(P<0.05)。结论:超声心动图监测下介入封堵术可有效降低CHD患者炎症反应,对调节其心功能状态及血浆ANP水平具有积极影响。

Objective：To investigate the effect of interventional closure under echocardiography on right ventricular function in patients with congenital heart disease（ CHD）. Methods：The clinical data of 42 patients with CHD（ CHD group,n = 42） who received interventional closure under monitoring of echocardiography and 40 healthy subjects（ control group,n = 40） in our hospital between April 2013 and May 2015 were retrospectively analyzed. The left ventricular function indexes [left ventricular ejection fraction（ LVEF）,left ventricular end diastolic diameter（ LVEDD）,left ventricular end systolic diameter（ LVESD） ],right ventricular function indexes [right ventricular end diastolic/systolic volume,right ventricular ejection fraction（ RVEF） ],levels of inflammatory cytokines [interleukin-6（ IL-6）,C-reactive protein（ CRP）,tumor necrosis factor alpha（ TNF-α） ] and plasma atrial natriuretic peptide（ ANP） were compared between the two groups. Results：LVEDD,LVESD,right ventricular end diastolic volume,right ventricular end systolic volume,levels IL-6,CRP,TNF-α and plasma ANP in control group were significantly lower than those in CHD group in different time periods,while LVEF and RVEF were significantly higher than those in CHD group（ P〈0. 05）. At postoperative 1 month and 3 months,levels of LVEDD and LVESD,right ventricular end diastolic volume,right ventricular end systolic volume,levels of IL-6,CRP,TNF-α and plasma ANP in CHD group were significantly lower than those before operation while LVEF and RVEF levels were significantly higher（ P〈0. 05）. Conclusions：The interventional closure under monitoring of echocardiography can effectively reduce the inflammatory reactions in patients with CHD and has a positive effect on the regulation of cardiac function and plasma ANP level.