超声检测卵圆孔面积联合血流动力学在新生儿房间隔缺损诊断中的应用
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摘要
目的探讨超声检测卵圆孔面积(FOA)联合血流动力学在新生儿房间隔缺损(ASD)诊断中的应用。方法回顾性选取2014年12月至2017年12月本院收治的ASD新生患儿597例,以产后超声或手术证实为对照,依据是否发生ASD分为ASD组(48例)和正常组(549例),所有新生儿均于分娩前给予超声检测FOA、血流动力学[分流速度(DV)]水平,分析卵圆孔面积联合血流动力学对新生儿ASD的诊断价值。结果 ASD组房缺组患儿卵圆孔直径、面积、分流速度明显高于正常组,有显著性差异(P<0.05);ROC曲线分析结果显示,在诊断胎儿ASD的敏感度、特异度、准确度方面,FOA以13mm2为临界值时分别为79.17%、90.16%、89.29%,DV以0.7m/s为临界值时分别为77.08%、89.07%、88.11%,二者联合时分别为93.75%、95.99%、95.81%在诊断新生儿房缺的敏感性、特异性和准确性方面,二者联合明显高于二者单独时,差异有统计学意义(P<0.05),二者单独时基本相同,差异无统计学意义(P<0.05)。结论 FOA、血流动力学DV水平变化与新生儿ASD的发生有关,检测二者水平可作为诊断新生儿ASD的重要参考指标,且二者联合时具有更佳的诊断效能,值得临床作进一步推广。
Objective:To discuss the application of ultrasonic detection of oval area(FOA)combined with hemodynamics in the diagnosis of neonatal atrial septal defect(ASD). Methods:Retrospective study of 597 newborn children with ASD from December 2014 to December 2017 in our hospital was reviewed,comparison of postpartum ultrasound or surgery. According to whether ASD was divided into group ASD(48 cases)and normal group(549 cases).All newborns were given FOA,hemodynamics [shunt speed(DV)] before delivery,and to analyze the value of oval hole area combined with hemodynamics in the diagnosis of neonatal ASD. Results:The diameter,area and diffluence rate of the oval foramen in the ASD group were significantly higher than that in the normal group,the difference was statistically significant(P<0.05). ROC curve analysis showed that the sensitivity,specificity and accuracy of predicting the diagnosis of fetal ASD.The critical value of FOA with 13 mm2 was 79.17%,90.16%,and 89.29%,respectively. The critical value of DV with 0.7 m/s was 77.08%,89.07%,and 88.11%,respectively. The combination of the two were 93.75%,95.99%,and 95.81%,respectively.In predicting the sensitivity,specificity and accuracy of neonatal atrial septal defect,the combination of the two was significantly higher than that of the two,the difference was statistically significant(P<0.05). The two are basically the same when they are alone,the difference was not statistically significant(P<0.05). Conclusion:The changes of FOA and hemodynamic DV were related to the occurrence of ASD in the newborn. The detection of two levels can be used as an important reference index for predicting ASD in newborn infants.And the combination of the two has a better diagnostic efficiency,it′s worth for further clinical promotion.
Objective:To discuss the application of ultrasonic detection of oval area(FOA)combined with hemodynamics in the diagnosis of neonatal atrial septal defect(ASD). Methods:Retrospective study of 597 newborn children with ASD from December 2014 to December 2017 in our hospital was reviewed,comparison of postpartum ultrasound or surgery. According to whether ASD was divided into group ASD(48 cases)and normal group(549 cases).All newborns were given FOA,hemodynamics [shunt speed(DV)] before delivery,and to analyze the value of oval hole area combined with hemodynamics in the diagnosis of neonatal ASD. Results:The diameter,area and diffluence rate of the oval foramen in the ASD group were significantly higher than that in the normal group,the difference was statistically significant(P<0.05). ROC curve analysis showed that the sensitivity,specificity and accuracy of predicting the diagnosis of fetal ASD.The critical value of FOA with 13 mm2 was 79.17%,90.16%,and 89.29%,respectively. The critical value of DV with 0.7 m/s was 77.08%,89.07%,and 88.11%,respectively. The combination of the two were 93.75%,95.99%,and 95.81%,respectively.In predicting the sensitivity,specificity and accuracy of neonatal atrial septal defect,the combination of the two was significantly higher than that of the two,the difference was statistically significant(P<0.05). The two are basically the same when they are alone,the difference was not statistically significant(P<0.05). Conclusion:The changes of FOA and hemodynamic DV were related to the occurrence of ASD in the newborn. The detection of two levels can be used as an important reference index for predicting ASD in newborn infants.And the combination of the two has a better diagnostic efficiency,it′s worth for further clinical promotion.
引文
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[10]刘金凤,杨亚利,谢明星,等.血流向量成像评价房间隔缺损手术前后右心室舒张期流场变化[J].中国医学影像技术,2016,32(2):243-247.
[11]Ro R,Halpern D,Sahn DJ,et al.Vector flow mapping in obstructive hypertrophic cardiomyopathy to assess the relationship of early systolic left ventricular flow and the mitral valve[J].J Am Coll Cardiol,2014,64(19):1984-1995.
[12]Kotby AA,Taman KH,Sedky HT,et al.Atrial natriuretic peptide as a marker of heart failure in children with left ventricular volume overload[J].J Paediatr Child Health,2013,49(1):43-47.
[13]陈洁,曾燕荣,孙文清,等.超声评估胎儿卵圆孔血流受限的应用价值[J].临床超声医学杂志,2014,16(9):646-647.
[14]孙丹丹,侯颖,侯传举,等.应用三尖瓣血流速度图评估肺动脉高压的研究[J].中国医学影像学杂志,2017,25(1):13-16.
[15]吴文谦,刘金凤,刘曼薇.改良的血流向量成像技术评价房间隔缺损患者舒张期心室血流流场特征[J].临床超声医学杂志,2017,19(3):150-154.
[16]程志颖,周瑞涛,王少华.超声心动图关于胎儿卵圆孔及卵圆孔瓣与先天性心脏病房间隔缺损相关性的研究[J].赤峰学院学报:自然科学版,2015,31(12):93-94.
[17]Soni LK,Cedola SR,Cogan J,et al.Right atrial lesions do not improve the efficacy of a complete left atrial lesion set in the surgical treatment of atrial fibrillation,but they do increase procedural morbi-dity[J].J Thorac Cardiovasc Surg,2013,145(2):356-361.
[2]Brenner R,Pratali L,Rimoldi SF,et al.Exaggerated pulraonary hypertension and right ventricular dysfunction in high-altitude dwellers with patent foramen ovale[J].Chest,2015,147(4):1072-1079.
[3]郭丽娜,吴卫华,马兰.实时三维经食管超声心动图测定房间隔缺损最大径的价值评估[J].中国临床医学,2016,23(6):749-753.
[4]刘新波,李有金,陈家华,等.房间隔缺损介入治疗前后左心功能及血流动力学指标变化[J].宁夏医学杂志,2013,35(3):237-239.
[5]Ko HK,Yu J J,Cho EK,et al.Segmental Analysis of Right Ventricular Longitudinal Deformation in Children before and after Percutaneous Closure of Atrial Septal Defect[J].J Cardiovase Ultrasound,2014,22(4):182-188.
[6]吴丽文,陆世红,匡永芳.超声心动图在经胸微创房间隔缺损封堵术中的应用[J].岭南现代临床外科,2015,15(3):342-344.
[7]Lange SA,Braun MU,Schoen SP,et al.Latent pulmonaryhypertension in atrial septal defect:dynamic stress echocardiographyreveals unapparent pulmonary hypertension and confirmsrapid normalisation after ASD closure[J].Neth Heart J,2013,21(7-8):333-343.
[8]Clifton L,Daniel B,Richard S,et al.Robotic repair of sinusvenosus atrial septal defect with partial anomalous pulmonaryvenous return and persistent left superior vena cava[J].Innovations,2014,9(5):388-390.
[9]杨春燕,贾焕荣,许平,等.新生儿重症监护室床旁超声心动图筛查的临床意义[J].中华实用儿科临床杂志,2013,28(20):1597-1598.
[10]刘金凤,杨亚利,谢明星,等.血流向量成像评价房间隔缺损手术前后右心室舒张期流场变化[J].中国医学影像技术,2016,32(2):243-247.
[11]Ro R,Halpern D,Sahn DJ,et al.Vector flow mapping in obstructive hypertrophic cardiomyopathy to assess the relationship of early systolic left ventricular flow and the mitral valve[J].J Am Coll Cardiol,2014,64(19):1984-1995.
[12]Kotby AA,Taman KH,Sedky HT,et al.Atrial natriuretic peptide as a marker of heart failure in children with left ventricular volume overload[J].J Paediatr Child Health,2013,49(1):43-47.
[13]陈洁,曾燕荣,孙文清,等.超声评估胎儿卵圆孔血流受限的应用价值[J].临床超声医学杂志,2014,16(9):646-647.
[14]孙丹丹,侯颖,侯传举,等.应用三尖瓣血流速度图评估肺动脉高压的研究[J].中国医学影像学杂志,2017,25(1):13-16.
[15]吴文谦,刘金凤,刘曼薇.改良的血流向量成像技术评价房间隔缺损患者舒张期心室血流流场特征[J].临床超声医学杂志,2017,19(3):150-154.
[16]程志颖,周瑞涛,王少华.超声心动图关于胎儿卵圆孔及卵圆孔瓣与先天性心脏病房间隔缺损相关性的研究[J].赤峰学院学报:自然科学版,2015,31(12):93-94.
[17]Soni LK,Cedola SR,Cogan J,et al.Right atrial lesions do not improve the efficacy of a complete left atrial lesion set in the surgical treatment of atrial fibrillation,but they do increase procedural morbi-dity[J].J Thorac Cardiovasc Surg,2013,145(2):356-361.