改良剑突下三尖瓣环位移半定量评估漏斗胸患儿右心室收缩功能的应用

Application of modified tricuspid annulus displacement semi-quantitative evaluation of right ventricular systolic function in children with funnel chest

目的探究和分析改良剑突下三尖瓣环位移(displacement of tricuspid annulus under sword protrusion,SEATAK)半定量评估漏斗胸患儿右心室收缩功能的应用效果。方法选择昆明医科大学附属儿童医院自2017年1月至2019年1月收治的40例漏斗胸患儿作为研究对象(设为研究组),另选择同期来本院进行体检的40名正常儿童作为参照对象(设为对照组),两组受试儿童均行超声心动图检查,对比漏斗胸患儿与健康儿童以及漏斗胸患儿术前、术后的胸骨旁三尖瓣收缩期位移(tricuspid annular plane systolic excursion,TAPSE)、SEATAK、右心室Tei指数(right ventricular Tei index,RV-Tei)、右心室面积变化分数(right ventricular fractional area change,RVFAC)、右心室射血分数(right ventricular ejection fraction,RVEF)等右心室功能参数。结果漏斗胸患儿TAPSE、SEATAK、RV-Tei、RVFAC、RVEF均显著低于健康儿童,差异有统计学意义(P<0.05)。漏斗胸患儿术后的TAPSE、SEATAK、RV-Tei、RVFAC、RVEF均显著高于术前,差异有统计学意义(P<0.05)。术前漏斗胸患儿SEATAK减低的程度与TAPSE呈正相关(r=0.692,P<0.001),SEATAK减低的程度与RVFAC呈正相关(r=0.715,P<0.001);术后SEATAK增高的程度与TAPSE呈正相关(r=0.73,P<0.05)。术后,学龄前期组与学龄期组患儿SEATAK、TAPSE及RVFAC增高较青春前期组及青春期组患者明显,差异有统计学意义(P<0.05)。结论SEATAK半定量评估漏斗胸患儿右心室收缩功能的应用效果显著,值得推广。

Objectives To explore and analyze the effect of semi-quantitative evaluation of right ventricular systolic function by semi-quantitative displacement of tricuspid annulus under sword protrusion(SEATAK)in children with funnel chest.Methods Totally 40 children with funnel chest treated in Children's Hospital Affiliated to Kunming Med⁃ical University from January 2017 to January 2019 were selected as study group,and 40 normal children performed physical examination in our hospital at the same period were selected as control group.Echocardiography was performed in all the two groups.Tricuspid annular plane systolic excursion(TAPSE),SEATAK,right ventricular Tei index(RV-Tei),right ventricular fractional area change(RVFAC),right ventricular ejection fraction(RVEF)was measured and compared in children with funnel chest before and after operation and between children with funnel chest and healthy children.Results TAPSE,SEATAK,RV-Tei,RVFAC and RVEF in children with funnel chest were signifi⁃cantly lower than those in healthy children,and the differences between the two groups were statistically significant(P<0.05).TAPSE,SEATAK,RV-Tei,RVFAC and RVEF were significantly higher after operation than before opera tion in children with funnel chest with statistically significant(P<0.05).The degree of SEATAK reduction in children with funnel chest positively correlated with TAPSE(r=0.692,P<0.001)and RVFAC(r=0.715,P<0.001).The degree of increasing postoperative SEATAK positively correlated with TAPSE(r=0.73,P<0.05).The increasing of SEATAK,TAPSE and RVFAC in preschool and school age groups were significantly higher than those in prepuberty and puberty groups(P<0.05).Conclusions The semi-quantitative evaluation of right ventricular systolic function in children with funnel chest with semi-quantitative SEATAK is effective and worth popularizing.