心肺联合超声在法洛四联症儿童围术期中的临床应用价值

Application Value of Cardiopulmonary Ultrasound on Perioperative Rehabilitation of Pediatric Patients with Tetralogy of Fallot

目的探讨心肺联合超声(CPUS)在法洛四联症(TOF)婴幼儿围术期监测中的临床应用价值。方法选取2020年2月至2020年9月在中国医学科学院阜外医院进行一期根治手术治疗的TOF患儿54例。于术后2 h进行CPUS检查,记录左室射血分数(LVEF),右室面积变化分数(FAC),肺超声评分,残余室间隔缺损,瓣膜反流及胸腹腔积液情况,同时记录临床监测及实验室指标。根据术后机械通气时间是否大于48 h分为延迟恢复组(22例)及正常恢复组(32例),比较2组间参数,选择具有统计学意义的超声参数制定CPUS评分,评价其与呼吸机时间及ICU时间的相关性。结果2组患儿在年龄、性别、经皮氧饱和度、McGoon比值、术前LVEF、右室FAC等基线资料上无统计学差异(P>0.05)。延迟恢复组患儿跨环补片者多于正常恢复组(P<0.05)。2组患儿临床监测及实验室指标差异无统计学意义(P>0.05)。超声参数中,2组间左室舒张末内径、肺动脉瓣峰值跨瓣压差及存在残余室间隔缺损者无统计学差异(均P>0.05);延迟恢复组LVEF及右室FAC低于正常恢复组,肺超声评分高于正常恢复组,存在肺动脉瓣反流≥中量及胸腹腔积液者均多于正常恢复组(均P<0.05)。CPUS评分预测延迟恢复的ROC曲线下面积为0.893,最佳截断值为6,敏感性68%,特异性91%。Kaplan-Meier曲线示CPUS≥6分者与<6分者比较,呼吸机时间及ICU时间均较长,差异具有统计学意义(均P<0.05)。结论CPUS对TOF根治术后患儿围术期监测具有较高临床价值,可以评价心室功能、肺内渗出情况,从而指导围术期治疗,促进术后快速康复。

Objective To investigate the application value of cardiopulmonary ultrasound(CPUS)on perioperative rehabilitation of pediatric patients with tetralogy of Fallot(TOF).Methods From February 2020 to September 2020,a total of 54 children who underwent primary repair of TOF in Fuwai Hospital were included.CPUS examination was performed to assess the left ventricular ejection fraction(LVEF),right ventricular fractional area change(FAC),lung ultrasound score,residual ventricular septal defect,valvular regurgitation and effusion.Clinical data and laboratory indexes were also collected.Patients were divided into two groups:delayed recovery group(22 cases)and normal recovery group(32 cases)according to whether the postoperative mechanical ventilation time was more than 48 hours.Parameters between the two groups were compared,and statistically significant ultrasonic parameters were selected to develop CPUS scores,and their correlation with ventilator duration and ICU duration was evaluated.Results There were no statistically significant differences in age,sex,percutaneous oxygen saturation,McGoon ratio,preoperative LVEF,right ventricular FAC and other baseline data between the two groups(all P>0.05).More children in the delayed recovery group needed transannular patch than in the normal recovery group(P<0.05).There was no statistically significant difference in clinical and laboratory indicators between the two groups(all P>0.05).Among the ultrasonic parameters,there were no statistically significant differences between the two groups in left ventricular end-diastolic diameter,peak pressure gradient of pulmonary valve and residual ventricular septal defect(all P>0.05).LVEF and right ventricular FAC in the delayed recovery group were lower,while pulmonary ultrasound score was higher than those in the normal recovery group(all P<0.05).Patients with pulmonary valve regurgitation more than moderate and pleural effusion were more in the delayed recovery group(all P<0.05).The area under the ROC curve predicted by CPUS score was 0.893,the best cutoff value was 6,the sensitivity was 68%,and the specificity was 91%.Kaplan-meier curve showed that patients with CPUS≥6 had longer ventilator duration and ICU duration than those with<6 points(all P<0.05).Conclusion CPUS is of high clinical value for perioperative monitoring of children after TOF repair.It can evaluate ventricular function and pulmonary exudation,so as to guide perioperative treatment and promote postoperative rapid recovery.