腺样体扁桃体手术后肺动脉压及双心室功能的时间依赖性变化：一项组织多普勒超声心动图研究。

文献信息

中文摘要

目的： 腺样体扁桃体肥大引起的上气道阻塞可能通过慢性胸腔内负压和肺血管负荷增加影响儿童心脏。本研究使用常规超声心动图和组织多普勒成像（TDI）评估腺样体扁桃体手术后肺动脉压及左右心室收缩和舒张功能随时间的变化。
方法： 这项前瞻性观察性研究纳入了5-11岁、经临床和内镜确诊为腺样体扁桃体肥大并接受腺样体切除术、扁桃体切除术或腺样体扁桃体切除术的非肥胖儿童。由同一操作者在术前及术后1个月和6个月进行超声心动图检查。我们评估了收缩期肺动脉压（sPAP）、常规超声心动图指标、三尖瓣和二尖瓣环平面收缩期位移（TAPSE和MAPSE）、组织多普勒收缩和舒张速度、心肌性能指数（MPI）以及双心室射血时间（ET）。
结果： sPAP随时间显著下降，经Bonferroni校正后，三个时间点之间均存在显著差异。TAPSE和MAPSE在术前均在年龄校正的正常范围内，但两者均随时间发生显著变化。TAPSE逐渐增加，而MAPSE在两次术后随访时均高于基线。右心室TDI显示侧壁e'速度和三尖瓣e'/a'比值存在显著时间效应；侧壁s'无显著变化。在二尖瓣环，侧壁e'、间隔e'和间隔a'存在显著时间效应。经Bonferroni校正后，仅侧壁e'在6个月时高于基线，而间隔a'仅在1个月与6个月之间存在差异。双心室MPI和ET均无显著变化，常规超声心动图指标在整个随访期间保持正常。
结论： 腺样体扁桃体手术与肺动脉压早期下降及双心室不同的变化模式相关。右心室变化更为显著，包括TAPSE早期且进行性增加，而左心室舒张变化出现较晚且较为有限。由于常规超声心动图指标保持正常，TDI轻度变化的临床意义尚不确定。

英文摘要

PURPOSE: Upper airway obstruction caused by adenotonsillar hypertrophy may affect the heart in children through chronic negative intrathoracic pressure and increased pulmonary vascular load. This study evaluated changes over time in pulmonary artery pressure and right and left ventricular systolic and diastolic function after adenotonsillar surgery using conventional echocardiography and tissue Doppler imaging (TDI).
METHODS: This prospective observational study included non-obese children aged 5-11 years with clinically and endoscopically confirmed adenotonsillar hypertrophy who underwent adenoidectomy, tonsillectomy, or adenotonsillectomy. Echocardiography was performed before surgery and at 1 and six months after surgery by the same operator. We assessed systolic pulmonary artery pressure (sPAP), conventional echocardiographic measures, tricuspid and mitral annular plane systolic excursion (TAPSE and MAPSE), tissue Doppler systolic and diastolic velocities, myocardial performance index (MPI), and ejection time (ET) for both ventricles.
RESULTS: SPAP decreased significantly over time, with significant differences between all three time points after Bonferroni adjustment. TAPSE and MAPSE were within age-adjusted normal ranges before surgery but both changed significantly over time. TAPSE increased progressively, while MAPSE was higher at both postoperative visits than at baseline. Right ventricular TDI showed significant time effects for lateral e' velocity and the tricuspid e'/a' ratio; lateral s' did not change significantly. In the mitral annulus, significant time effects were seen for lateral e', septal e', and septal a'. After Bonferroni adjustment, only lateral e' was higher at six months than at baseline, while septal a' differed only between 1 and six months. MPI and ET did not change significantly in either ventricle, and conventional echocardiographic measures remained normal throughout follow-up.
CONCLUSION: Adenotonsillar surgery was associated with an early fall in pulmonary artery pressure and different patterns of change in the two ventricles. Right ventricular changes were more prominent, including an early and progressive increase in TAPSE, while left ventricular diastolic changes were later and more limited. Because conventional echocardiographic measures remained normal, the clinical importance of the modest TDI changes is uncertain.