儿童法洛四联症围术期右心收缩功能的实时三维超声评估及术后右心功能影响因素分析

摘要

Objective: To assess the perioperative right ventricular systolic function in pediatric patients with tetralogy of Fallot(TOF) who went through total correction surgery by real-time three dimensional echocardiography(RT3DE) and analyze the related factors with immediate postoperative right ventricular systolic function. Methods: To compare the right ventricular systolic functional parameters measured by RT3DE such as right ventricular end diastolic volume (RVEDV), end systolic volume (RVESV) and ejection fraction(RVEF) before and two or three days after surgical correction, and then using statistical analysis to explore the related clinical factors with post-RVEF. Results: Compared with the preoperative measurements, in two or three days after surgery, RVEDV and RVEF were significantly reduced, while RVESV was not changed significantly. Good correlation between the post-operative RVEF and four factors including adoption of trans-annular patch surgery, aortic cross-clamp time, residual shunting between two ventricles and residual obstruction of right ventricular outflow tract were found to be significant statistically. Adoption of the trans-annular patch surgery and aortic cross-clamp time were the more related factors with the post-operative RVEF. Conclusions: Right ventricular systolic function in children with TOF immediate after total correction surgery is reduced and mainly correlated with four operative factors. It is helpful to maintain the immediate post-operative right ventricular systolic function by shortening the aortic cross-clamp time, adopting the non-trans-annular patch surgery as well as completely correcting the anatomic deformities.%目的:应用实时三维超声心动图(RT3DE)对行根治术的法洛四联症(TOF)儿童围术期右心收缩功能进行评估,并探讨其术后右心收缩功能的影响因素.方法:对42例TOF患儿围术期右心室收缩末容积(RVESV)、舒张末容积(RVEDV)和射血分数(RVEF)等进行RT3DE测量,并比较术前、术后以上3项右心功能指标的变化情况.同时,收集患儿围术期临床资料,探讨术后近期右心收缩功能的主要影响因素.结果:与术前相比,术后2～3d RVEDV、RVEF均降低,RVESV无显著性变化.跨瓣补片与否、升主动脉阻断时间、术后残余梗阻和术后残余分流的存在与否与术后RVEF变化呈良好相关性,其中,升主动脉阻断时间和跨瓣补片与否是影响术后近期右心收缩功能的主要因素.结论:儿童TOF根治术后近期右心收缩功能降低,主要与升主动脉阻断时间、跨瓣补片与否以及术后残余分流和梗阻等因素有关,提示术中缩短升主动脉阻断时间、尽量施行非跨瓣补片以及完全纠正解剖畸形对术后近期TOF患儿右心收缩功能的维持具有重要意义.