摘要
目的利用左心声学造影(left ventricular opacification,LVO)联合实时三维超声心动图(real-time three-dimensional echocardiography,RT-3DE)研究心肌梗死后室间隔穿孔(post-infarction ventricular septal rupture,PI-VSR)患者的局部形态及手术前后左心功能,评估影响室间隔穿孔(ventricular septal rupture,VSR)患者死亡的相关危险因素。方法PI-VSR患者28例,手术治疗19例,比较手术患者二维超声、RT-3DE和LVO检测VSR最大径、部位、数目、形状与手术结果的一致性,在LVO条件下联合RT-3DE对比手术前后左心功能指标的变化情况。根据患者一般资料及临床资料探究影响生存预后的独立危险因素。结果①LVO与RT-3DE检测VSR最大径与手术结果比较差异无统计学意义(均P>0.05)。LVO检测VSR部位、数目、形状与手术结果的一致性较好(均P<0.05)。RT-3DE检测VSR部位、形状与手术结果的一致性较好(均P<0.05)。其中LVO对部位和形状的检测与术中结果一致性的Kappa值分别为0.650、0.883。LVO观察VSR形状的敏感性为0.923,特异性为1.000,准确性为0.947,阳性预测值为1.000,阴性预测值为0.857。②LVO联合RT-3DE检测术后患者左心功能得到显著改善,左心功能指标差异均有统计学意义(均P<0.05)。③影响患者30 d生存率的独立危险因素包括:性别、Killips泵功能分级、是否外科手术。结论LVO与RT-3DE可提供更准确的VSR最大径、部位、数目及形状等解剖学信息,为治疗方案的选择提供依据。LVO联合RT-3DE评估手术前后左心功能的改变,可为临床评价预后提供参考。
Objective To study the local morphology of post-infarction ventricular septal rupture(PI-VSR)and the left ventricular function before and after operation and to evaluate the relevant risk factors of death in patients with PI-VSR by using left ventricular opacification(LVO)combined with real-time three-dimensional echocardiography(RT-3DE).Methods Twenty-eight patients with PI-VSR and 19 patients undergoing surgical treatment were selected.The consistency of two-dimensional ultrasound,RT-3DE and the detection of LVO on the maximum diameter,location,number and shape of ventricular septal rupture(VSR)with the surgical results were compared.Through LVO combined with RT-3DE,the changes of left ventricular function indexes before and after surgery were compared.According to the general data and clinical data of patients,independent risk factors affecting survival and prognosis were explored.Results①There was no significant difference between LVO and RT-3DE in detecting VSR maximum diameter and surgical results(all P>0.05).The location,number and shape of VSR detected by LVO were consistent with the surgical results(all P<0.05).RT-3DE had good consistency in detecting VSR location,shape and surgical results(all P<0.05).Among them,of LVO′s detection of VSR location and shape and the Kappa values of consistence of the intraoperative results were 0.650 and 0.883 respectively.LVO had a sensitivity of 0.923,specificity of 1.000,accuracy of 0.947,positive predictive value of 1.000 and negative predictive value of 0.857 in observing VSR shape.②LVO combined with RT-3DE was used to evaluate the left ventricular function of postoperative patients.The parameters of left ventricular function improved significantly(all P<0.05).③The independent risk factors affecting the 30 d survival rate included:gender,Killips pump function classification,and whether or not surgery was performed.Conclusions LVO and RT-3DE can provide more accurate anatomical information such as VSR maximum diameter,location,number and shape,which provides the basis for the selection of treatment strategy.LVO combined with RT-3DE can evaluate the changes of left ventricular function before and after surgery,which can provide reference for clinical evaluation of prognosis.
作者
赵娜
滑少华
王红鹄
齐清华
杨雨
张瑞芳
Zhao Na;Hua Shaohua;Wang Honghu;Qi Qinghua;Yang Yu;Zhang Ruifang(Department of Ultrasound,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华超声影像学杂志》
CSCD
北大核心
2019年第11期933-939,共7页
Chinese Journal of Ultrasonography
关键词
超声心动描记术
实时三维
室间隔穿孔
左心声学造影
危险因素
Echocardiography,real-time three-dimensional
Ventricular septal rupture
Left ventricular opacification
Risk factor
