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目的采用M型超声、二维超声(2DE)及实时三维超声(RT3DE)对患有法洛四联症(TOF)的婴幼儿进行左心收缩功能评估及对比研究,探讨各方法对TOF患儿围手术期左心室收缩功能评估的可行性及局限性,以期指导临床应用。方法选取在我院确诊为TOF且年龄小于4周岁的患儿102例(术前54例,术后2～3d48例),分别采用M型超声、2DE引导下的双平面Simpson法、RT3DE引导下的双平面Simp-son法以及RT3DE全容积重建法测量TOF患儿左心室射血分数(LVEF),对比以上方法与RT3DE全容积重建法测值的一致性及各方法的重复性。结果 2DE引导下的双平面Simpson法和RT3DE引导下的双平面Simpson法所测LVEF与RT3DE全容积重建法测值一致性较好(R值分别为0.38和0.96,P<0.001),而M型超声测值与RT3DE全容积重建法无显著相关性(P=0.11),进一步将病例分为术前及术后两组发现,术前M型超声测值与RT3DE全容积重建测值一致性较好(R=0.37,P=0.008),而术后M型测值与RT3DE全容积重建测值无显著相关性(P=0.083)。相比全容积重建法,RT3DE引导下的双平面Simpson法低估左心室舒张末容积。RT3DE所测左心室舒张末容积(LVEDV)和LVEF,三维引导下的Simpson法、二维引导下的Simpson法以及M型超声所测LVEF的观察者内变异分别为(7±4)%,(6±3)%,(4±2)%,(10±7)%,(6±3)%;观察者间变异分别为(15±6)%,(10±5)%,(7±5)%,(14±11)%,(11±4)%。结论 RT3DE引导下的双平面Simpson法及RT3DE全容积重建法对TOF围手术期左心室功能评估具有较高的可行性,2DE引导下的双平面Simpson法次之;而M型超声总体评估效果较差,并主要体现在对TOF术后患儿的心功能评估上。各测量方法重复性均在临床可接受范围内。
Objective To evaluate the left ventricular systolic function in infants with tetralogy of Fallot (TOF) and compare the two methods with M-mode ultrasound, two-dimensional ultrasound (2DE) and real-time three dimensional ultrasound (RT3DE) Perioperative assessment of left ventricular systolic function of the feasibility and limitations, with a view to guiding clinical application. Methods Totally 102 children (less than 4 years old) and TOF diagnosed in our hospital were selected. M-mode ultrasound, biplane Simpson method under 2DE and RT3DE Dimensional bipolar Simp-son method and RT3DE volumetric reconstruction method to measure the left ventricular ejection fraction (LVEF) in children with TOF. The consistency between the above methods and RT3DE volumetric reconstruction method and the repeatability of each method were compared. Results 2DE-guided biplane Simpson method and RT3DE-guided biplane Simpson method showed good agreement between LVEF and RT3DE volumetric reconstruction (R = 0.38 and 0.96, P <0.001), while M There was no significant correlation between ultrasound and total volume reconstruction of RT3DE (P = 0.11). The cases were further divided into preoperative and postoperative groups, the preoperative M-mode ultrasonic measurements and RT3DE volumetric reconstructions were consistent (R = 0.37, P = 0.008). There was no significant correlation between postoperative M type measurement and total volumetric reconstruction of RT3DE (P = 0.083). Compared with the whole volume reconstruction method, RT3DE-guided biplane Simpson method underestimates the left ventricular end-diastolic volume. Left ventricular end-diastolic volume (LVEDV) and LVEF measured by RT3DE, Simpson’s method under three-dimensional guidance, Simpson’s method under two-dimensional guidance and LVEF measured by M-mode ultrasound were (7 ± 4)%, 6 ± 3%, 4 ± 2%, 10 ± 7% and 6 ± 3% respectively. The interobserver variability was (15 ± 6)%, (10 ± 5)%, (7 ± 5)%, (14 ± 11)%, (11 ± 4)%. Conclusions RT3DE-guided biplane Simpson method and RT3DE volumetric reconstruction method are more feasible for the assessment of perioperative left ventricular function in patients with TOF. 2D-Simpson method followed by 2DE is the second most effective method. The overall evaluation of M-mode ultrasound is more effective Poor, and mainly reflected in the assessment of heart function in children with TOF. Repeatability of each measurement method are within the clinically acceptable range.