应用Tei指数对小儿法洛四联症根治术后近、远期心功能的评价

目的用Tei指数评价小儿法洛四联症(tetralogy of Fallot,TOF)根治术后心脏的收缩、舒张功能。方法2009年1月至2010年12月广东省心血管病研究所应用多普勒超声心动图测定TOF根治术后患儿各阶段的Tei指数,其中60例为根治术后早期(≤1年)、55例为根治术后远期(>10～15年),将各阶段Tei指数进行比较,并与正常组165名进行对照分析。结果 (1)正常组心室Tei指数不受年龄、心率影响,左心室、右心室Tei指数比较,差异无统计学意义(P值均>0.05)。(2)TOF根治术患儿左心室Tei指数于术前和术后1周、3个月、半年与正常组比较均明显升高,差异有统计学意义(P<0.01);于术后1年与正常组比较,差异无统计学意义(P>0.05);于术后10～15年又明显升高,与正常组比较,差异有统计学意义(0.41±0.22 vs.0.23±0.11,P<0.01)。(3)TOF根治术患儿的右心室Tei指数于术前和术后3个月、半年、1年与正常组比较,差异无统计学意义(P>0.05);仅于术后1周升高,与正常组比较,差异有统计学意义(0.31±0.22 vs.0.22±0.13,P<0.05);于术后10～15年又明显升高,与正常组比较,差异有统计学意义(0.30±0.19 vs.0.22±0.13,P<0.01)。结论 TOF根治术后,患儿左心室Tei指数恢复较慢,右心室Tei指数主要于术后1周明显升高,两者于长期随访中又有明显升高。Tei指数可以用来评价心脏的整体功能,为小儿TOF根治术前、后的左及右心室收缩、舒张功能的综合评价提供了一种新的方法。

Evaluating cardiac function in short-and long-term after total correction of tetralogy of Fallot in children by Tei-index

Objectives To evaluate cardiac systolic and diastolic functions after total correction of tetralogy of Fallot （TOF） in children by Tel-index. Methods Tel-index of each phase after total correction of TOF in 115 children was assayed by echocardiography from January 2009 to December 2010 in Guangdong Cardiovascular Institute. Of the 115 children, 60 children were in short-term （≤1 year） group and 55 children were in long-term （〉10-15 years） group. Tel-indexes of short term group, long-term group and normal control group （n=165） were compared. Results （ 1 ） Age and heart rate had no effect on Tel-index of normal group, and there were no significant differences between left ventricle （LV） Tel-index and right ventricle （RV） Tel-index （P〉0.05）. （2） Compared with those of normal children, LV Tel-indexes of TOF children markedly increased before, one week, three months and six months after total correction of TOF （P〈0.01） ; then they decreased to normal level one year after total correction and had no apparent difference with those of normal children （P〉0.05） ; whilst they went up dramatically 10-15 years later again, and had significant dift）renee comparing with those of normal group （0.41±0.22 vs. 0.23±0.11, P〈0.01 ）. （3） RV Tel- indexes remained normal in TOF children before, three months, six months and one year after total correction of TOF with no remarkable differences comparing with those of normal group （P〉0.05） ; but they increased one week after totalcorrection and had significant difference with those of normal group （0.31±0.22 vs. 0.22±0.13,P〈0.05）; by 10-15 years after total correction of TOF, there was a remarkable increase in these Tei-indexes comparing with those of normal group （0.30±0.19 vs. 0.22±0.13, P〈0.01 ）. Conclusions LV Tei-index recovers slowly while RV Tei-index increases noticeably mainly in one week after total correction. Both have notable rises during long-term follow-up. As a result, by applying Tei-index, the integrated cardiac function can be evaluated and a new way is meanwhile provided for an overall evaluation of systolic and diastolic functions of both LV and RV before and after total correction of TOF in children.