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目的探讨法洛四联症(TOF)根治术后近期室间隔矛盾运动(PSM)的发生率及对术前后左心容积变化及收缩功能的影响并结合临床资料分析此类患者PSM产生的可能原因。方法采用实时三维超声(RT3DE)定量评估47例TOF患儿术前及术后2~3 d左心室舒张末容积指数(LVEDVI)、左心室收缩末容积指数(LVESVI)及左心室射血分数(LVEF)等指标,并根据三维全容积图像切割后的心尖四腔切面和短轴切面对PSM进行定性评估,对比分析合并PSM组和非合并PSM组患儿手术前后容积变化情况及术后左心收缩功能,结合手术因素、右心室相关病变及传导束病变等临床资料探讨PSM产生的可能原因。结果对比术前情况,术后2~3 d 47例TOF患儿LVEDVI无显著性变化(P=0.694),LVESVI有所增加(P<0.001),而LVEF显著下降(P<0.001);进一步研究发现,25例患儿术后LVEDVI增大,而22例患儿术后LVEDVI减小,同时47例TOF患儿中有21例合并PSM(44.7%),Pearson卡方检验显示PSM的存在与患儿术后LVEDVI减小密切相关(χ2=20.34,P<0.001)。合并PSM的患儿术后2~3 d LVEF测值相比非合并者低(P=0.021);TOF根治术后近期患儿PSM的产生与升主动脉阻断时间的长短(P=0.753)及术后合并左、右束支传导阻滞的相关性并不大,Pearson卡方检验显示合并PSM患儿同时伴右心室流出道梗阻的概率更大(χ2=4.309,P=0.038)。结论 TOF患儿术后近期室间隔矛盾运动的发生率较高(44.7%)并显著影响患儿术后左心容积变化及左心室收缩功能,此异常运动的产生一定程度上与右心室流出道梗阻相关。
Objective To investigate the incidence of ventricular septal contractile disorder (PSM) after radical resection of tetralogy of Fallot (TOF) and its influence on the changes of left ventricular volume and systolic function before and after the operation and to analyze the clinical data of PSM the reason. Methods Quantitative assessment of left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic volume index (LVESVI) and left ventricular ejection fraction (LVEF) were performed in 47 children with TOF by real-time three- LVEF) and other indicators, and according to the three-dimensional volume image of the apex after the four-chamber view of the transection and short axis of the PSM qualitative assessment of children with and without PSM combined PSM volume changes before and after surgery and left Cardiac systolic function, combined with surgical factors, right ventricular lesions and conductive bundle lesions and other clinical data to explore the possible causes of PSM. Results There was no significant change in LVEDVI in 47 children with TOF between 2 and 3 days after operation (P = 0.694), LVESVI (P <0.001), and LVEF (P <0.001) Found that 25 patients had increased LVEDVI after surgery, while 22 patients had a decrease in postoperative LVEDVI, while 21 of 47 children with TOF had PSM (44.7%). The Pearson Chi-square test showed the presence and severity of PSM The decrease of LVEDVI after operation was closely related (χ2 = 20.34, P <0.001). The LVEF in children with PSM was significantly lower than that in non-patients (P = 0.021) 2 and 3 days after operation. The incidence of PSM and the duration of ascending aorta occlusion in children with TOF after radical resection (P = 0.753) (P <0.05). The Pearson chi square test showed that the incidence of right ventricular outflow tract obstruction was also higher in children with PSM (χ2 = 4.309, P = 0.038). Conclusions The incidence of contracted septal ventricular septum movement in children with TOF is relatively high (44.7%) and significantly affects left ventricular volume and left ventricular systolic function after operation in children with TOF. The abnormal movement is associated with the right ventricular outflow tract Obstruction related.