Fallo tetradasini radikal korreksiya qilishdan so‘ng bolalarda o‘ng qorincha funksiyasining exokardiografik ko‘rsatkichlari dinamikasi
Qabul qilingan: 2026-10-03
Nashr etilgan: 2026-03-30
Annotatsiya
Dolzarbligi. Fallo tetradasini radikal korreksiya qilgandan keyin o‘ng qorincha funksiyasini baholash operatsiyadan keyingi miokard disfunksiyasini erta aniqlash va keyingi kuzatuv taktikasini belgilashda muhim ahamiyatga ega. Shu bilan birga, operatsiyadan keyingi erta davrda o‘ng qorinchaning uzunlamasiga sistolik funksiyasini ifodalovchi an’anaviy ko‘rsatkichlarning pasayishi nafaqat miokardning haqiqiy shikastlanishi, balki sternotomiya va perikardiotomiyadan so‘ng yurak geometriyasi hamda qisqarish mexanikasining o‘zgarishi bilan ham bog‘liq bo‘lishi mumkin.
Tadqiqot maqsadi. Fallo tetradasini radikal korreksiya qilgandan keyin bolalarda o‘ng qorincha funksiyasining exokardiografik ko‘rsatkichlari dinamikasini baholash hamda bemor yoshi va jarrohlik korreksiyasi turining operatsiyadan keyingi tiklanish xususiyatlariga ta’sirini aniqlash.
Materiallar va usullar. Fallo tetradasi bo‘lgan va radikal jarrohlik korreksiyasidan o‘tgan 101 nafar bolada retrospektiv-prospektiv tadqiqot o‘tkazildi. Transtorakal exokardiografiya operatsiyadan oldin, operatsiyadan keyingi birinchi sutkada, 1 oy va 3 oy o‘tgach bajarildi. TAPSE, z-TAPSE, trikuspidal halqaning lateral segmenti sistolik harakat tezligi S′ va z-S′, o‘ng qorincha maydonining fraksion o‘zgarishi (FAC), o‘pka regurgitatsiyasi darajasi, shuningdek chap qorinchaning oxirgi diastolik hajmi va indekslangan oxirgi diastolik hajmi baholandi.
Natijalar. Operatsiyadan keyingi birinchi sutkada TAPSE 14,85±1,76 mm dan 6,80±1,50 mm gacha (p<0,0001), S′ 12,13±1,23 sm/s dan 6,20±1,24 sm/s gacha (p<0,0001), FAC esa 44,45±6,40% dan 28,72±6,15% gacha (p<0,0001) sezilarli darajada kamaydi. 3-oyga kelib TAPSE 13,10±1,86 mm gacha, S′ esa 11,03±1,14 sm/s gacha oshdi. Bemor yoshi kuzatuvning barcha bosqichlarida TAPSE mutlaq qiymatlariga statistik jihatdan sezilarli ta’sir ko‘rsatdi (p<0,0001); yosh bilan operatsiyadan keyingi birinchi sutkadan 3 oygacha TAPSE o‘sishi o‘rtasida musbat korrelyatsiya aniqlandi (r=0,556; p<0,0001). Birinchi sutkada TAPSE va S′ ning eng past ko‘rsatkichlari transannulyar plastika qilingan bemorlarda qayd etildi; korreksiya turlari o‘rtasidagi farqlar mos ravishda p=0,006 va p=0,007 darajasida statistik jihatdan ahamiyatli bo‘ldi, biroq 1–3 oyga kelib bu farqlar yo‘qoldi. Chap qorinchaning indekslangan oxirgi diastolik hajmi 40,00±15,05 dan 59,40±11,06 ml/m² gacha izchil oshdi (p<0,0001).
Xulosa. Fallo tetradasini radikal korreksiya qilgandan keyin darhol TAPSE va S′ ning keskin pasayishi operatsiyadan keyingi erta davrga xos qonuniy hodisa bo‘lib, keyingi uch oy davomida ushbu ko‘rsatkichlarning sezilarli tiklanishi kuzatiladi. O‘ng qorincha funksiyasini talqin qilish TAPSE, S′, ularning z-ko‘rsatkichlari va FAC ni kompleks baholashga, shuningdek bolaning yoshi va bajarilgan jarrohlik korreksiyasi turini majburiy hisobga olishga asoslanishi lozim.
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