本文選題：對比增強經(jīng)胸超聲心動圖 + 對比增強經(jīng)顱多普勒超聲��； 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：背景與目的:卵圓孔未閉(patent foramen ovale,PFO)相關(guān)右向左分流占所有右向左分流(right-to-left shunt,RLS)疾病的95%。大量研究表明PFO與一系列腦血管事件相關(guān),機制為卵圓孔未閉使左、右心房形成交通,為反常栓塞提供通道,反常栓子隨著右向左反常血流直接進(jìn)入動脈循環(huán),導(dǎo)致隱源性腦卒中、反復(fù)卒中發(fā)作、短暫性缺血性發(fā)作、偏頭痛等疾病。因此臨床中對PFO-RLS的診斷及分流量分級評估成為研究熱點。由于經(jīng)食道超聲心動圖(Transesophageal echocardiography,TEE)檢查會引起患者不適感,因此臨床初篩PFO時應(yīng)用TEE并不廣泛,目前對比增強經(jīng)胸超聲心動圖(Contrast Transthoracic Echocardiography,c-TTE)、對比增強經(jīng)顱多普勒超聲(Contrast Transcranial Doppler,c-TCD)兩種檢查方法應(yīng)用廣泛,但對于哪種檢查方法對PFO的檢出及分流量分級評價更有效,不同的研究所持觀點不同。因此,本研究收集了因頭疼就診于吉大一院神經(jīng)內(nèi)科的患者,并同時、同步進(jìn)行c-TTE、c-TCD兩項檢查,以明確兩種方法在診斷PFO-RLS及評估RLS分級中的價值。本研究隨機入組231名因頭疼就診吉林大學(xué)第一醫(yī)院神經(jīng)內(nèi)科患者,均在靜息狀態(tài)、執(zhí)行傳統(tǒng)的Valsalva動作后及執(zhí)行標(biāo)準(zhǔn)化Valsalva動作后同時、同步進(jìn)行c-TTE及c-TCD檢查。c-TTE及c-TCD均根據(jù)造影劑微泡(Microbubbles,MB)數(shù)目分為4個等級。并根據(jù)c-TCD檢查將RLS進(jìn)行分類。將c-TTE及c-TCD檢查的陽性率及RLS半定量分級比較;不同類型RLS的分級比較。結(jié)果:本研究入組231名患者,女性158名,占68.4%,男性73名,占31.6%,平均年齡36.9±11.6歲。兩種檢查方法比較,在RS狀態(tài)下、傳統(tǒng)的Valsalva動作后及標(biāo)準(zhǔn)化Valsalva動作后c-TTE檢出RLS陽性率均高于c-TCD,差異均具有統(tǒng)計學(xué)意義(P0.001)。評價PFO-RLS分級c-TTE檢查優(yōu)于c-TCD檢查且差異有統(tǒng)計學(xué)意義(H=6.533 P0.001)。c-TCD檢查評價RLS分級固有型RLS(constant RLS)高于激發(fā)型RLS(provoked RLS)且差異有統(tǒng)計學(xué)意義(Z=-3.832 p0.001);c-TTE檢查評價RLS分級程度固有型RLS與激發(fā)型RLS差異無統(tǒng)計學(xué)意義(Z=-1.234 p=0.217);c-TCD檢查將入組患者分為RLS陽性組及RLS陰性組,應(yīng)用c-TTE檢查評價該兩組RLS分級陽性組高于陰性組,且差異有統(tǒng)計學(xué)意義(Z=-5.150 p0.001)。所有入組患者中檢出房間隔膨出瘤(atrial septal aneurysm,ASA)者共5例,執(zhí)行Valsalva動作后,分流量增大。結(jié)論:1:c-TTE檢查在診斷PFO-RLS陽性率及評估RLS分級優(yōu)對象及方法:于c-TCD檢查。2:c-TCD檢查評價固有型RLS分流量大于激發(fā)型RLS,c-TCD對不同類型RLS分級差異對比分析優(yōu)于c-TTE檢查。3:需要進(jìn)行RLS檢查的患者,建議c-TTE與c-TCD兩種檢查聯(lián)合應(yīng)用,既提高診斷PFO-RLS陽性率,也可以評價不同類型RLS分級。4:本研究合并有ASA的PFO-RLS分流量較大,執(zhí)行Valsalva動作后c-TTE及c-TCD兩種檢查方法評價RLS分流量均較靜息狀態(tài)下有所增加。
[Abstract]:Background & AIM: the right to left shunt (RLSs) associated with patent foramen ovale (OMQ) accounts for 95% of all right to left shunt (RLSs) diseases.A large number of studies have shown that PFO is related to a series of cerebrovascular events, and the mechanism is that the left and right atrium are communicated by the patent foramen ovale, which provides a channel for abnormal embolism, and abnormal embolus flows directly into the arterial circulation with the right to left abnormal blood flow.Causes cryptogenic stroke, recurrent stroke, transient ischemic attack, migraine and other diseases.Therefore, the diagnosis and flow grading of PFO-RLS has become a hot research topic.Because transesophageal echocardiography can cause discomfort in patients, TEE is not widely used in clinical screening of PFO.At present, contrast-enhanced transthoracic Transthoracic echocardiography and contrast-enhanced transcranial Transcranial Doppler echocardiography c-TCD are widely used. However, these two methods are more effective for the detection and grading of PFO.Different research institutes hold different views.Therefore, this study collected the patients who were admitted to the Department of Neurology for headache, and at the same time, carried out c-TTET c-TCD simultaneously to determine the value of the two methods in the diagnosis of PFO-RLS and the evaluation of RLS grading.In this study, a total of 231 patients in the Department of Neurology, first Hospital of Jilin University, were randomly enrolled in the study. All of them were in resting state, performing traditional Valsalva and performing standardized Valsalva at the same time.C-TTE and c-TCD were performed simultaneously. C-TTE and c-TCD were divided into four grades according to the number of microbubbles.RLS was classified according to c-TCD examination.The positive rate of c-TTE and c-TCD and the semi-quantitative grading of RLS were compared, and the grades of different types of RLS were compared.Results: there were 231 patients in this study, 158 women (68.4%), 73 males (31.66.6years) with an average age of 36.9 鹵11.6 years.The positive rate of RLS detected by traditional Valsalva and standardized Valsalva was higher than that of c-TCD.The difference was statistically significant (P 0.001).The evaluation of PFO-RLS grade c-TTE was better than c-TCD, and the difference was statistically significant. The evaluation of RLS grading intrinsic RLS(constant was higher than that of exciting RLS(provoked by P0.001).c-TCD 6.533 P0.001).c-TCD examination, and the difference was statistically significant.There was no significant difference in type type RLS. The patients were divided into RLS positive group and RLS negative group.The RLS grading positive group was higher than the negative group by c-TTE examination, and the difference was statistically significant.In all the patients, atrial septal neoplasms (ASA) were detected in 5 cases. After Valsalva, the flow was increased.Conclusion the diagnostic positive rate of PFO-RLS and the evaluation of RLS grade were evaluated by 1: 1 / c-TTE. Methods: in c-TCD examination, the partial flow of RLS was larger than that of activated RLSc-TCD, and the difference between different RLS grades was better than that of c-TTE. 3: it was necessary to evaluate the difference between different RLS grades. 3: 1: 2: TCD was better than RLSc-TCD in evaluating the flow of RLS in different types of RLS.Patients undergoing RLS,It is suggested that the combination of c-TTE and c-TCD can not only improve the positive rate of PFO-RLS diagnosis, but also evaluate the different types of RLS grade. 4. In this study, the PFO-RLS shunt volume with ASA is larger.Both c-TTE and c-TCD methods were used to evaluate the flow of RLS after Valsalva.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R540.45;R541.1

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