摘要
目的探讨法洛四联症心内修复术（repaired tetralogy of Fallot，rTOF）后患者（儿）中期右心室功能减低的危险因素。方法采用病例对照方法，46例rTOF患者（儿）和46例健康志愿者行年龄配对t检验。记录超声心动图检查各项指标结果。rTOF患者（儿）三尖瓣侧壁瓣环处的收缩期峰速（st’）、舒张早期峰速（Et’和舒张晚期（At，低于健康对照组（P〈0．05）。然后以st’的中位数为截点将rTOF患者（儿）分为两组：A组St’〈7em／s，19例，为右心室功能明显减低组；B组St’≥7em／s，27例，为右心室功能轻度异常。年龄、MeGoon比值、RVP／LVP和超声心动图各指标比较采用t检验，性别、病史和心功能分级等率的比较采用r检验，P〈0．05为差异有统计学意义。单因素分析检验A组和B组之间的所有基础变量与右心室功能的关系，多因素logistic回归分析对P〈0．1的变量进行检验，以筛选出影响TOr患者（儿）右心室功能减低的独立危险因素，P〈0．05为差异有统计学意义。结果rTOF患者（儿）中期右心室功能减低的独立危险因素为手术时年龄（P=0．040，OR=1．678，95％CI为1．023～2．752）和肺动脉瓣反流程度（P=0．043，OR=0．023，95％CI为0．001—0．889），术前MeGoon比值、复查时年龄、右心室收缩压、左心室舒张末容积指数、右心室流出道内径、主动脉瓣环内径、主动脉窦部内径、At（m／s）、At〈m／s）均不是右心室功能减低的危险因素。结论手术时年龄和肺动脉瓣反流程度是rTOF患者（儿）中期右心室功能减低的独立危险因素。患者（儿）手术年龄越小、肺动脉瓣反流越重，术后中期右心室功能减低越明显。采用恰当术式降低肺动脉瓣反流可有效维持TOF术后中长期右心室功能。
Objective Most of patients with repaired tetralogy of Fallot （rTOF） survived in long-term, but existed with generally decreased exercise capacity, right ventricular （RV） dilatation owing to RV dysfunction. The case-control study is in- tended to investigate predictive factors on postoperative RV dysfunction in rTOF patients. Methods 46 rTOF patients and 46 age-matched healthy volunteers were studied. With age-matched t test, firstly found that the systolic （ St＇）, early diastolic （E（） ,and late diastolic（ At＇） peak velocities at lateral tricuspid of annulus in patients are lower than those in controls （P 〈 0.05 ）. Then According to median of St＇as cut-off, rTOF patients were divided into group A （St＇〈 7 cm/s, 19 cases） and group B （StY7 cm/s, 27 cases）. Uni-factor regression analysis was done to examine the possible relationships between base- line variables and postoperative right ventricular dysfunction. Variables with P 〈 0.1 were then included in the multiple linear regression analysis to assess the ＂best＂ subset in predicting postoperative RV dysfunction. Results The multivariate analysis found that only pulmonary regurgitation （PR） degree （ P = 0.043, OR = 0.023,95% CI 0.001 - 0.889 ） and age at repair （ P = O. 040, OR = 1. 678, 95 % CI between 1. 023 - 2. 752 ） predict mid-term RV dysfunction in rTOF patients. Othervariables （ i. e. McGoon ratio, postoperative RV and LV systolic pressure ratio, mid-term RV systolic pressure and so on） did not predict postoperative RV dysfunction. Deceased in late diastolic peak velocity at lateral tricuspid of annulus （At＇） and St＇were the characteristic of postoperative RV dysfunction. Conclusion RV dysfunction in rTOF patients was severity and included pas- sive relaxation function and contraction function. An appropriate surgery intended to relieve pulmonary regurgitation is an effec- tive strategy of sustaining TOF patients＇postoperative RV function.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2013年第11期671-674,共4页
Chinese Journal of Thoracic and Cardiovascular Surgery
