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研究生:廖仲斌
研究生(外文):Chung-Pin
論文名稱:即時三度立體心臟超音波應用於心房中隔缺損測量之研究
論文名稱(外文):The Effect of Transthoracic Real-Time Three-Dimensional Echocardiography for measuring Atrial Septal Defect
指導教授:李怡靜李怡靜引用關係
學位類別:碩士
校院名稱:中山醫學大學
系所名稱:醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2007
畢業學年度:95
語文別:中文
論文頁數:91
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心房中隔缺損(Atrial Septal Defect, ASD)在先天性心臟病中,屬於常見疾病之一,尤其在成年人的先天性心臟病當中,發生率更是首居第一。傳統對於心房中隔缺損的治療方法是以開心手術為主,但近幾年介入性心導管治療的進步,使用心房中隔關閉器(Amplatzer Septal Occulder, ASO)治療心房中隔缺損已成為一種可以被接受的治療方式。在成功執行心房中隔關閉術時,準確的評估心房中隔缺損大小及周邊組織的情況是主要的關鍵;目前測量心房中隔缺損大小,以球囊測量導管(Balloon Stretched Diameter, BSD)的結果為黃金指標。但隨著超音波發展,即時三度立體心臟超音波(Real-Time Three-Dimensional Echocardiography, RT-3DE)可完整的呈現心房中隔缺損完整的立體空間結構,已成為臨床上先天性心臟病的有效診斷工具。
本篇研究旨在應用即時三度立體心臟超音波對心房中隔缺損的大小做為評估的主要方法,做進一步探討;再者使用其結果找出更有效及準確的心房中隔缺損大小測量方法,以利介入性心房中隔關閉術的成功進行。
樣本對象:50位繼發孔型心房中隔缺損(Secundum type ASD)的病人,併有右側心臟血流負荷過重(Volume overloading)的症狀,準備接受心房中隔關閉術的治療。
方法:在50位病人中,使用即時三度立體心臟超音波針對心房中隔缺損最大值的前後徑、上下徑、圓周及面積進行測量,其結果與球囊測量導管的測量數值進行二者間的線性迴歸分析,以瞭解二者數值間的關係;在二者中找出較好的正相關值,進而試著找出即時三度立體心臟超音波在心跳週期中的最佳測量方法。
結果:在50組資料分析後,即時三度立體心臟超音波的四組ASD最大值測量結果中,以圓周演算直徑與球囊測量導管最能呈現顯著的正相關(Y=0.996x+4.313, r=0.841);依據圓周測量結果為基準,來探討心跳循環中的準確性,其結果發現平均的圓周演算直徑相較於最大與最小圓周的演算直徑而言,與球囊測量導管的結果呈現更高的相關性(Y=0.790x+3.59, r=0.908)。最後所有50位病人皆完成心房中隔關閉術的診斷。
結論:在心房中隔缺損病人中,使用即時三度立體心臟超音波測量時,以心房中隔缺損的圓周演算直徑與球囊測量導管測量結果呈現高度正相關;而就整個心跳週期中,取最大及最小圓周的平均值圓周演算直徑的結果,比以最大或最小的圓周演算直徑結果更為準確。

Atrial septal defect(ASD) is one of the most frequent lesions in congenital heart disease especially in adult. Surgical repair of an ASD is a low-risk and widely accepted procedure. In near years, ASD transcatheter occlusion techniques have become an alternative to surgical procedure. Then, ASD size measurement is paramount importance for the successful deployment of a transcatheter septal occulder(ASO). Until now, the balloon stretched diameter(BSD)has long been regarded as the gold standard for selection size of any device. Be along with echocardiography development, real-time three-dimensional echocardiography(RT-3DE)accurately defined ASD location, size, and surrounding atrial anatomy.
The study aim was to compare the BSD and RT-3DE methods to measure the ASD size. Further, to use these results to get the greater method of measurement in the cardiac cycle.
Population: The fifty heart failure patients referred for transcatheter closure of a secundum ASD were enrolled.
Method: In all fifty patients, maximal diameter of the defect including: antero-posterior, supero-inferior, derived from circumference, and derived from area measurement were performed in each patients when the defect hole appeared mazimal in size during the cardiac cycle. Then, comparing these data and BSD measurement, and finding the best correlation in these datas of RT-3DE. Finally, in the best correlation data, to find the good measurement in the cardiac cycle.
Result: After statistical analysis, RT-3DE measurement of diameter derived from circumference agreed well with the BSD (Y=0.996x+4.313, r=0.841). In this data, the mean diameter derived from circumference agreed well with the BSD (Y=0.790x+3.59, r=0.908). Transcatheter closure was pergormed successfully in fifty patients using the Amplatzer device closure.
Conclusion: In these patients with ASD, RT-3DE measurement of diameter derived from circumference was high correlation with BSD. In the heart cycle, mean diameter derived from circumference more agreed well with the BSD than maximum and minimum diameter derived from circumference. If we will find the best measurement of the ASD size, we need have more research and clinical experience.

目 錄
致 謝
目 錄
中文摘要
英文摘要

第壹章 緒論……………………………………………… 1
第一節 研究動機……………………………………...………. 1
第二節 研究目的……………………………………...………. 4
弟三節 重要名詞解釋………………………………………… 5

第貳章 文獻探討………………………………………… 6
第一節 心房中隔缺損之介紹及相關研究…………………... 6
第二節 心臟超音波檢查及相關研究………………………. 12
弟三節 心房中膈缺損關閉器之應用及相關研究………… 24

第參章 研究方法………………………………………. 30
第一節 研究樣本……………………………………………..30
第二節 研究架構………………………………...…………...31
第三節 研究設計………………………...………………….. 33
第四節 研究工具及方法……………………………………. 34
第五節 資料分析方法………………….………………...…. 41

第肆章 研究結果………………………………………43
第一節 樣本資料之描述性統計分析………………………. 43
第二節 測量結果之推論性統計分析………………………. 48

第伍章 討論與建議…………………………………. 51
第一節 資料分析結果討論…………………………………. 51
第二節 臨床應用建議………………………………………..55
第三節 研究限制………………………………………......... 56
第四節 結論………………………………………………......58

第陸章 參考文獻…………………………………….. 60
圖表與附件…………………………………………...... 68

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