右室舒张功能障碍对法洛四联症患者术后转归的影响

摘要

OBJECTIVE To investigate the impact of right ventricular diastolic dysfunction on the post - operative course in Tetralogy of Fallot ( TOF ) patients with echocardiography. METHODS Ninety patients ( mean age 3 months to 3 years ) with TOF underwent surgical correction were divided into two groups according to post -operative Doppler echocardiography analysis: the right ventricular restrictive physiology group ( Group A, n = 35 ) and the normal right ventricular diastolic function group ( Group B, n =55 ). Post - operative course including mechanical ventilation time, inotropic drug support time and post operative hospital time was compared between two groups. RESULTS Biventricular systolic function was normal in both groups. There was a marked inspiratory augmentation of pulmonary artery A wave velocity, flow integral and duration. Transtricuspid flow revealed significantly lower peak E velocity, lower E/A ratio, shorter E deceleration time and higher A velocity time integral in group A. Patients in group A had significantly longer ventilation ( 19.4 ± 9.5 h vs 10.6 ± 7.5 h, P ＜ 0.05 ), longer inotropic drug support duration ( 8.4 ± 1.5 d vs 6.1 ± 1.1 d, P ＜0. 01), and longer post operative hospital time( 10.1 ±3.5d vs8.4± 1.3 d, P ＜0. 01). CONCLUSION Right ventricular restriction exists in a significant subset of patients with tetralogy of Fallot following surgical repair and exerts unfavorable effects on post - operative course.%目的 应用超声分析婴幼儿法洛四联症根治术后右室舒张功能不全对术后病程转归的影响.方法 研究对象为我科90例法洛四联症术后婴幼儿患者(年龄3个月～3岁).术后根据脉冲多普勒血流分析结果判断有无右室舒张功能障碍(即右室限制性生理).将90例患儿分为右室限制性生理组(A组,n=35)和右室舒张功能正常组(B组,n=55).比较分析两组患儿术后病程转归的差异,包括术后呼吸机辅助时间、正性活性药物辅助时间、平均出院时间等.结果 两组患儿心室收缩功能均正常.A组患儿肺动脉前向血流在吸气相明显强于呼气相;三尖瓣血流E峰速度、E/A比值、E峰减速时间明显低于B组,A峰速时间积分高于B组.A组与B组相比术后呼吸机辅助时间[(19.4±9.5) h vs(10.6±7.5) h(P<0.05)]、正性活性药物应用时间[(8.4±1.5) d vs (6.1±1.1) d(P<0.01)]、术后住院时间[(10.1±3.5) d vs (8.4±1.3) d(P<0.01)]均明显高于B组.结论 法洛四联症根治术后部分患者存在右室舒张功能障碍,对术后病程的恢复有不利影响.