640层动态容积CT血管造影联合心脏超声评估经右颈内静脉封堵治疗小儿房间隔缺损的价值研究

Value of 640 dynamic volume CTA combined with ultrasound on heart in assessing the treatment of right internal jugular vein occlusion for pediatric atrial septal defect

目的:探讨640层动态容积CT血管造影(CTA)联合超声评估经右颈内静脉封堵治疗小儿房间隔缺损(ASD)的诊断价值。方法:选取医院收治的102例ASD患儿,采用随机数表法将患儿分为观察组(52例)和对照组(50例),均行经右颈内静脉封堵治疗,其中观察组采用640层动态容积CTA联合心脏超声评估指导ASD;对照组采用心脏超声评估ASD,观察两组患儿手术情况、手术前后心脏结构及功能。结果:观察组手术时间和心内操作时间分别明显短于对照组,差异有统计学意义(t=-4.283,t=-4.339;P<0.05)。观察组ASD等效圆直径、ASD横径及ASD上下径手术前后测量差值明显低于对照组,差异有统计学意义(t=-8.567,t=-15.325,t=-7.964;P<0.05)。观察组术后1年左房收缩末期横径(LAETD)、左心室舒张末期内径(LVEDD)和左室射血分数(LVEF)明显高于对照组,差异有统计学意义(t=2.807,t=2.473,t=2.670;P<0.05),而右心室舒张末期内径(RVEDD)、肺动脉内径(PAD)和右室射血分数(RVEF)明显低于对照组,差异有统计学意义(t=-3.404,t=-2.421,t=-3.491;P<0.05)。观察组术后7 d时血清心肌型脂肪酸结合蛋白(H-FABP)、心肌肌钙蛋白I(cTnI)及肌酸激酶同工酶(CK-MB)明显低于对照组,差异有统计学意义(t=-10.075,t=-11.814,t=-5.157;P<0.05)。结论:640层动态容积CTA联合超声检查能准确评估小儿ASD,有助于缩短经右颈内静脉封堵治疗的手术时间,可改善患儿心脏重构和心功能,对患儿心肌损伤轻。

Objective:To explore the value of 640 dynamic volume computed tomography angiography(CTA)combined with ultrasound in assessing the treatment of right internal jugular vein occlusion for pediatric atrial septal defect(ASD).Methods:A total of 102 pediatric patients with ASD who admitted to hospital were selected,and they were divided into observation group(n=52)and control group(n=50)as randomly number table method.Both groups underwent the treatment of trans right internal jugular vein occlusion.The observation group adopted 640 dynamic volume CTA combined with ultrasound on heart to assess and guide ASD,and the control group adopted ultrasound on heart to assess ASD.The surgical situation,and the cardiac structures and functions of two groups before and after surgery were observed.Results:The surgical time and the operation time inside the heart in the observation group were significantly shorter than those in the control group,with statistically significant differences(t=-4.283,t=-4.339,P<0.05),respectively.The differences before and after surgery in the ASD equivalent circle diameter,ASD transverse diameter,and ASD upper and lower diameter in the observation group were significantly lower than those in the control group,with statistically significant differences(t=-8.567,t=-15.325,t=-7.964,P<0.05),respectively.The left atrial end transverse diameter(LAETD),left ventricular end diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)at the 1st after surgery in the observation group were significantly higher than those in the control group(t=2.807,t=2.473,t=2.670,P<0.05),while the right ventricular end diastolic diameter(RVEDD),pulmonary artery diameter(PAD)and right ventricular ejection fraction(RVEF)in the observation group were significantly lower than those in the control group at the same time(t=-3.404,t=-2.421,t=-3.491,P<0.05),respectively.At the 7th d after surgery,the serum levels of heart myocardial fatty acid binding protein(H-FABP),cardiac troponin I(cTnI)and creatine kinase isoenzyme(CK-MB)in the observation group were significantly lower than those in the control group(t=-10.075,t=-11.814,t=-5.157,P<0.05),respectively.Conclusion:640 dynamic volume CTA combined with ultrasound examination can accurately evaluate pediatric ASD,which is help to shorten the operation time of the treatment of trans right internal jugular vein occlusion,and to improve cardiac reconstruction and cardiac function.The myocardial injury caused by that on children is less.