CAJ | 학술논문

目的应用TEE及经胸壁超声心动图(TTE)在探查心脏及主动脉弓潜在性栓塞源(PES)的相对价值, 并进一步了解主动脉弓动脉粥样硬化(AAA)在缺血性中风中的作用.方法所有患者进行了TTE及TEE检查;同时对所有患者进行了颈动脉实时超声,TCD, CT检查, 部分患者进行了DSA及MRI等检查.AAA分为三级:轻度、中度、重度或活动性动脉粥样硬化斑块.结果①TTE 不能发现主动脉弓病变; ②在TEE检查中: 31例(63%)在主动脉弓发现有动脉粥样硬化性病变.其中7例(14.1%)呈轻度病理性改变,9例(18.4%)呈中度病理性改变, 15例(30.6%)呈重度病理性改变, 该15例中11例患者无明显的颈内动脉及心脏疾患,其主动脉弓斑块可能是其脑栓塞的主要原因;两者比较,TEE对心脏及主动脉弓的PES的发现率为4 8.98%,而TTE仅为18.4%;33例患者伴有颈内动脉动脉粥样硬化(ICAA)改变;9例患者伴有心脏疾病;高龄及ICAA组AAA的发病率明显增高.结论 TEE是目前探查主动脉弓及心脏PES的一个较好的检查手段.主动脉弓动脉粥样硬化在缺血性中风中非常常见,AAA在缺血性脑血管病的病因学中是一个应该值得重视的潜在栓塞源.
목적응용TEE급경흉벽초성심동도(TTE)재탐사심장급주동맥궁잠재성전새원(PES)적상대개치, 병진일보료해주동맥궁동맥죽양경화(AAA)재결혈성중풍중적작용.방법소유환자진행료TTE급TEE검사;동시대소유환자진행료경동맥실시초성,TCD, CT검사, 부분환자진행료DSA급MRI등검사.AAA분위삼급:경도、중도、중도혹활동성동맥죽양경화반괴.결과①TTE 불능발현주동맥궁병변; ②재TEE검사중: 31례(63%)재주동맥궁발현유동맥죽양경화성병변.기중7례(14.1%)정경도병이성개변,9례(18.4%)정중도병이성개변, 15례(30.6%)정중도병이성개변, 해15례중11례환자무명현적경내동맥급심장질환,기주동맥궁반괴가능시기뇌전새적주요원인;량자비교,TEE대심장급주동맥궁적PES적발현솔위4 8.98%,이TTE부위18.4%;33례환자반유경내동맥동맥죽양경화(ICAA)개변;9례환자반유심장질병;고령급ICAA조AAA적발병솔명현증고.결론 TEE시목전탐사주동맥궁급심장PES적일개교호적검사수단.주동맥궁동맥죽양경화재결혈성중풍중비상상견,AAA재결혈성뇌혈관병적병인학중시일개응해치득중시적잠재전새원.
Objectives To determine the relative value of transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) in exploring the potential embolic source (PES) in heart and aortic arch and to study the clinical significance of aortic arch athersclerosis (AAA). Methods Forty-nine patients with cerebral embolism were included in this study. TEE and TTE were used to evaluate the potential source of emboli in aortic arch, heart and duplex in the carotid artery. An atherosclerotic lesion of the aortic arch was defined as normal, mild plaque, moderate plaque, and protruding plaque or mobile plaque. Results Of the 49 patients, 31(63%) patients showed evidence of AAA: 7 (14.1%) patients were mild, 9 (18.4%) were moderate and 15 (30.6%) were severe. In those 15 patients, 11 had neither severe ICAA nor heart disease. Thirty-three patients had internal carotid arterial atherosclerosis (ICAA). The potential sources of embolization of heart and aortic arch is 48.98% by TEE, but only 18.4% by TTE; 9 patients had heart disease. Age and ICAA were significantly correlated with AAA. Conclusion At present, TEE is a better method for exploring atherosclerotic lesions in the thoracic aorta. AAA is an important potential source of cerebral embolic stroke.