摘要
目的分析实时三维经食管超声心动图(RT-3D-TEE)在左心耳封堵术中的应用价值。方法采用前瞻性研究,抽取2020年1月至2022年12月于周口市中医院拟行左心耳封堵术的64例非瓣膜性心房颤动患者为研究对象,在经食管超声心动图(TEE)及X线造影引导下进行左心耳封堵术。于术中应用X线造影、二维经食管超声心动图(2D-TEE)及RT-3D-TEE测量患者左心耳深度、左心耳口最大径及左心耳口最小径,应用组内相关系数(ICC)分析2D-TEE与RT-3D-TEE测量结果与X线造影测量结果一致性,同时以RT-3D-TEE测量结果为依据选择封堵器型号,分析左心耳口最大径与封堵器型号之间的相关性,并对术后封堵效果进行评估。结果64例患者中封堵成功63例(98.44%),1例患者因左心耳深度浅、开口直径过大,封堵器放入后无法稳定,取消手术;术中X线造影、2D-TEE与RT-3D-TEE测量左心耳深度、左心耳口最小径比较,差异未见统计学意义(P>0.05);术中X线造影测量左心耳口最大径数值高于2D-TEE、RT-3D-TEE(P<0.05)。经ICC分析显示,2D-TEE测量左心耳口最大径与X线造影测量结果的ICC值为0.121,一致性一般;RT-3D-TEE测量左心耳口最大径与X线造影测量结果的ICC值为0.832,一致性较高。经Pearson相关性分析显示,2D-TEE与RT-3D-TEE测定的左心耳口最大径数值与封堵器尺寸均呈正相关(r均>0,P均<0.05),且RT-3D-TEE相关系数大于2D-TEE。结论在左心耳封堵术中,RT-3D-TEE在封堵器尺寸选择方面具有重要指导作用,能够准确评估左心耳口最大径及封堵效果,为临床提供更加全面可靠的依据。
Objective To analyze the application value of real-time three-dimensional transesophageal echocardiography(RT-3D-TEE)in left atrial appendage occlusion.Methods A prospective study was conducted.Sixty-four patients with nonvalvular atrial fibrillation who were to undergo left atrial appendage occlusion in Zhoukou Hospital of Traditional Chinese Medicine from January 2020 to December 2022 were selected as the study subjects,and left atrial appendage occlusion was performed under the guidance of transesophageal echocardiography(TEE)and X-ray radiography.During the operation,the depth,the maximum diameter and the minimum diameter of the left atrial appendage were measured by X-ray radiography,two-dimensional transesophageal echocardiography(2D-TEE)and RT-3D-TEE.The intraclass correlation coefficient(ICC)was used to analyze the consistency of the results of 2D-TEE and RT-3D-TEE with X-ray radiography.At the same time,the occluder model was selected according to the RT-3D-TEE measurement results,the correlation between the maximum diameter of the left atrial appendage and the occluder model was analyzed,and the occluder effect was evaluated.Results Among the 64 patients,63 cases(98.44%)were successfully occluded,and 1 patient canceled the operation,in which the occluder model was unstable because the left atrial appendage was shallow and the diameter of the opening was too large.There was no statistical significant difference in the depth and the minimum diameter of left atrial appendage measured by intraoperative X-ray radiography,2D-TEE and RT-3D-TEE(P>0.05).The maximum diameter of left atrial appendage measured by X-ray radiography during operation was higher than that measured by 2D-TEE and RT-3D-TEE(P<0.05).Results of ICC analysis showed that the ICC value between the maximum diameter of left atrial appendage measured by 2D-TEE and X-ray radiography was 0.121,with general consistency.The ICC value between the maximum diameter of the left atrial appendage measured by RT-3D-TEE and X-ray radiography was 0.832,with high consistency.Results of Pearson correlation analysis showed that the maximum diameter of left atrial appendage measured by 2D-TEE and RT-3D-TEE was positively correlated with the size of occluder(r>0,P<0.05),and the correlation coefficient of RT-3D-TEE was greater than 2D-TEE.Conclusions RT-3D-TEE plays an important guiding role in the selection of occluder size in the left atrial appendage occlusion,and it can accurately evaluate the maximum diameter of left atrial appendage and occlusion effect,which can provide a more comprehensive and reliable basis for clinical use.
作者
姚龙
Yao Long(Department of Ultrasound,Zhoukou Hospital of Traditional Chinese Medicine,Zhoukou 466000,China)
出处
《中国实用医刊》
2023年第7期94-97,共4页
Chinese Journal of Practical Medicine
关键词
左心耳封堵术
实时三维经食管超声心动图
二维经食管超声心动图
左心耳口最大径
Left atrial appendage occlusion
Real-time three-dimensional transesophageal echocardiography
Two-dimensional transesophageal echocardiography
Maximum diameter of left atrial appendage
