先天性心脏病患儿围术期三尖瓣环收缩期位移的初探

A preliminary study of tricuspid annular plane systolic excursion during perioperative period in children with congenital heart disease

目的研究左向右分流型先天性心脏病(先心病)患儿围术期三尖瓣环收缩期位移(tricuspid annular plane systolic excursion,TAPSE)的变化趋势、影响因素以及与预后的关系。方法选择2020年9月至2021年5月我院收治的左向右分流型先心病患儿共39例,其中男(17例),女(22例);房间隔缺损(16例),室间隔缺损(23例);年龄为2~84月,中位数20(7,36)月,体重(11.32±4.96)kg;缺损大小2.6~28 mm,中位数7.2(5.4,9.6)mm;体外循环时间(63±17)min;主动脉阻断时间16~62 min,中位数34(24,45)min;术前心力衰竭标志物N末端-脑钠肽前体(NT-proBNP)22~3148 pg/ml,中位数204(107,380)pg/ml。分别记录患儿术前(T1)、术后第1天(T2)以及术后第5天(T3)的超声心动图指标和NT-proBNP的值以及预后指标。结果术后第1天TAPSE较术前明显下降[(17.5±3.4)mm比(7.5±2.5)mm,P<0.05],术后第5天与术后第1天TAPSE无统计学差异[(7.5±2.5)mm比(8.0±1.7)mm,P>0.05];术前NT-proBNP和年龄是左向右分流型先心病患儿围术期TAPSE变化的影响因素:术前NT-proBNP越高、年龄越小,术后TAPSE降低程度越大;术前TAPSE与监护室时间、气管插管时间、住院时间、住院费用等预后指标均呈负性相关(P<0.05);术后第1天TAPSE与部分预后指标(除外气管插管时间)呈负性相关(P<0.05);术后第5天TAPSE与住院时间成负性相关(P<0.05)。结论左向右分流型先心病患儿术后三尖瓣环收缩期位移较术前下降,具有临床意义,应该进行深入研究。

Objective To explore the change of tricuspid annular plane systolic excursion(TAPSE)during perioperative period in congenital heart disease children with left-to-right shunt and its influencing factors as well as its value for the prodnosis.Methods From September 2020 to May 2021,a prospective study was conducted in39 children with left-to-right shunt during perioperative period,including 17 males and 22 females with 16 atrial septal defect and 23 ventricular septal defect,aged from 2 to 84 months with median of 20(7,36)months;the body mass was(11.32±4.96)kg;the size of the defect was 2.6-28 mm,with median of 7.2(5.4,9.6)mm;the cardiopulmonary bypass(CPB)time of(63±17)min;the aortic cross-clamping time was 16-62 min,with median of 34(24,45)min;the heart failure marker N-terminal proBNP(NT-proBNP)before cardiac surgery was 22-3148 pg/ml with median of 204(107,380)pg/ml.Before the operation(T1)and 1 day(T2)as well as 5 days(T3)after the cardiac surgery,the echocardiographic indexes,NT-proBNP values and prognostic indicators were recorded.Results TAPSE decreased from T1 to T2 significantly[(17.5±3.4)mm VS.(7.5±2.5)mm,P<0.05]but there was no significant difference between T2 and T3[(7.5±2.5)mm VS.(8.0±1.7)mm,P>0.05].Preoperative NT-proBNP and age were the influencing factors of the perioperative TAPSE changes:the higher preoperative NT-proBNP and the younger the age,the greater the postoperative TAPSE decrease.Preoperative TAPSE was negatively correlated with ICU time,endotracheal intubation time,length of hospital stay and hospitalization expenses(P<0.05);TAPSE at T2 was negatively correlated with prognostic indicators(except the time of tracheal intubation)(P<0.05);TAPSE at T3 was negatively correlated with the length of hospital stay(P<0.05).Conclusion The tricuspid annular plane systolic excursion decreased on congenital heart disease patients with left-to-right shunt after cardiac surgery,and should be further studied.