發(fā)布時(shí)間：2018-02-21 16:14

  本文關(guān)鍵詞： 卵圓孔未閉 隱匿性卒中 經(jīng)顱多普勒對(duì)比增強(qiáng)試驗(yàn) 經(jīng)食道超聲心動(dòng)圖　出處：《山西醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:對(duì)小于55歲的隱源性卒中(cryptogenic stroke CS)患者行經(jīng)顱多普勒對(duì)比增強(qiáng)試驗(yàn)(contrast-enhanced transcranial doppler,cTCD)和經(jīng)食道超聲心動(dòng)圖(transesophageal echocardiography,TEE)判斷卵圓孔未閉(patent foramen ovale PFO),比較二者的優(yōu)劣,并總結(jié)相關(guān)CS患者的磁共振成像的特點(diǎn),為PFO相關(guān)性缺血性卒中的診斷提供線索。方法:本研究選取2014年1月至2016年12月山西省人民醫(yī)院神經(jīng)內(nèi)科收治的不明原因腦卒中患者49例,所有患者均先后進(jìn)行了cTCD和TEE檢查,常規(guī)檢測(cè)TCD,尋找最佳血管為監(jiān)測(cè)血管,cTCD用1ml空氣、8ml生理鹽水及患者自身血液1ml制作的激活鹽水作為造影劑,結(jié)合咳嗽及valsalva動(dòng)作,觀察大腦中動(dòng)脈頻譜,記錄10s內(nèi)探測(cè)到微氣泡信號(hào),在雙側(cè)大腦中動(dòng)脈記錄到5個(gè)或5個(gè)以上氣泡信號(hào)記為陽(yáng)性,其中29例患者cTCD和TEE檢查結(jié)果均為陰性,18例患者cTCD和TEE結(jié)果均為陽(yáng)性,2例患者cTCD結(jié)果陽(yáng)性而TEE未發(fā)現(xiàn)微氣泡信號(hào)。將雙陽(yáng)性患者記為A組,雙陰性患者記為B組,由另一名影像醫(yī)師評(píng)價(jià)顱腦DWI成像,按梗死數(shù)目多少,兩組患者的分別分為單發(fā)和多發(fā)。按梗死分布特點(diǎn),分為前循環(huán)、后循環(huán)、前后循環(huán)和雙前循環(huán),探討其影像學(xué)的特點(diǎn)。結(jié)果:以經(jīng)食道超聲作為標(biāo)準(zhǔn),經(jīng)顱多普勒診斷PFO的靈敏度為100%,特異度為93.1%。按梗死灶多寡,AB兩組患者組間比較差異有顯著性(P0.05)。前者更易發(fā)生多發(fā)的梗死。按梗死分布特點(diǎn),前后循環(huán)之間與后循環(huán)和前后循環(huán)之間進(jìn)行組間兩兩比較,兩組間差異均有統(tǒng)計(jì)學(xué)意義,PFO相關(guān)的腦卒中更容易累及后循環(huán)。結(jié)論:用cTCD診斷中青年隱源性卒中患者的卵圓孔未閉具有高度的敏感性和特異性,且操作安全,可作為卵圓孔未閉篩查的有效手段,能大大減少經(jīng)食道超聲帶來(lái)的痛苦和并發(fā)癥。PFO相關(guān)性腦卒中和其他來(lái)源的梗死相比較,后循環(huán)的多發(fā)性梗死較多見(jiàn),這種臨床和影像學(xué)特點(diǎn)能為臨床診斷提供線索。
[Abstract]:Objective: to compare the advantages and disadvantages of contrast-enhanced transcranial doppler echocardiography (TCD) and transesophageal echocardiography (TEE) in patients with cryptogenic stroke with cryptogenic foramen oval foramen ovale (foramen ovale PFOE), and to compare the advantages and disadvantages of contrast-enhanced transcranial doppler echocardiography (TCD) and transesophageal echocardiography (TEE) in the diagnosis of foramen ovale PFOE in patients with cryptogenic stroke. The characteristics of magnetic resonance imaging in patients with CS were summarized. Methods: from January 2014 to December 2016, 49 patients with unexplained cerebral apoplexy treated in Department of Neurology, Shanxi Provincial people's Hospital, were examined by cTCD and TEE respectively. Routine detection of TCD was performed to find the best blood vessel for monitoring vascular cTCD with 1 ml of normal saline in air and 1 ml of activated saline made in patient's own blood as contrast agent. Combined with cough and valsalva movements, the spectrum of middle cerebral artery was observed. Microbubble signals were detected within 10 seconds, and 5 or more bubbles were recorded in bilateral middle cerebral arteries as positive. The results of cTCD and TEE in 29 cases were all negative. The results of cTCD and TEE in 18 cases were both positive. The results of cTCD were positive in 2 cases, but no microbubble signal was found in TEE. The double positive patients were recorded as group A and the patients with double negative as group B. According to the number of infarction, the patients in the two groups were divided into single and multiple according to the number of infarction, according to the distribution of infarction, they were divided into anterior circulation, posterior circulation, posterior circulation and double anterior circulation. Results: transesophageal ultrasound was used as the standard. The sensitivity of transcranial Doppler in the diagnosis of PFO was 100 and the specificity was 93.1. There was a significant difference between the two groups according to the number of infarcts and the number of infarcts in AB group. The former was more prone to multiple infarcts, and according to the characteristics of infarct distribution, there was a significant difference between the two groups. A comparison was made between the two groups between the front and back cycles and between the back and back cycles, The difference between the two groups is statistically significant. PFO-related stroke is more likely to involve posterior circulation. Conclusion: the diagnosis of patent foramen ovale with cTCD in young and middle-aged patients with cryptogenic stroke is highly sensitive, specific and safe. Can be used as an effective means to screen the foramen ovale, can greatly reduce the pain and complications caused by transesophageal ultrasound. PFO-related stroke compared with other sources of infarction. This clinical and imaging feature can provide clues for clinical diagnosis.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R743.3

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