CAJ | 학술논문

目的：了解健康人卵圆孔未闭（PFO）右向左分流（RLS）和（或）来源于肺部的RLS（P-RLS）的检出率。方法随机选取健康成年志愿者42名，进行经食管超声心动图（TEE）和经胸超声心动图（TTE）常规检查。另外，分别在静息状态和Valsalva动作过程中上肢静脉快速注入手振0.9%氯化钠溶液10 ml，进行经胸超声心动图右心造影（cTTE），根据右心显影后左心房微泡出现的时间区分来PFO-RLS与P-RLS；根据进入左心房的微泡数量将RLS半定量划分为3个等级：1级为少量微泡进入左心房（1~10个微泡/帧图像）；2级为中量微泡进入左心房（11~30个微泡/帧图像）；3级为大量微泡进入左心房（＞30个微泡/帧图像）。对以下几个方面进行观测和统计分析：（1）健康成年人PFO的发生率、大小及RLS检出率；（2）健康成年人是否存在P-RLS及其检出率；（3）RLS与Valsalva动作的关系；（4）不同起源RLS的半定量分级比较。结果42名健康志愿者中， TEE诊断PFO 13名（13/42，30%），PFO宽（1.46±0.18）mm（1~3 mm），长（7.23±1.09）mm （4~14 mm）。cTTE检出RLS共30名（30/42，71%），其中4名同时存在PFO-RLS和P-RSL， PFO-RLS为12名（12/42，29%），P-RLS为22名（22/42，52%）。除1名受检者外，PFO-RLS的检出均与Valsalva动作有关，PFO-RLS多出现在Valsalva动作结束的瞬间；而P-RLS多出现在静息状态下（14名），部分出现在Valsalva动作后（8名）。不同来源RLS检出率的差异有统计学意义（χ2=4.941， P=0.026）。TEE诊断PFO与cTTE检出PFO-RLS一致者共11名。有2名TEE诊断PFO，但cTTE未检出PFO-RLS；有1名cTTE检出PFO-RLS，但TEE未诊断PFO。PFO-RLS与P-RLS半定量分级的差异有统计学意义（Z=-3.901，P=0.000）。在12名PFO-RLS中，2级和3级各有6名；在22名P-RLS中，1级11名，2级10名，3级仅1名。结论 PFO及其伴随的暂短微量RLS在健康成年人群中检出率约为1/4，PFO-RLS的检出必须辅以Valsalva动作。在健康人群中存在着半定量分级相对PFO-RLS较低的P-RLS，其检出率、影响因素及其临床意义尚待更多研究。目的：瞭解健康人卵圓孔未閉（PFO）右嚮左分流（RLS）和（或）來源于肺部的RLS（P-RLS）的檢齣率。方法隨機選取健康成年誌願者42名，進行經食管超聲心動圖（TEE）和經胸超聲心動圖（TTE）常規檢查。另外，分彆在靜息狀態和Valsalva動作過程中上肢靜脈快速註入手振0.9%氯化鈉溶液10 ml，進行經胸超聲心動圖右心造影（cTTE），根據右心顯影後左心房微泡齣現的時間區分來PFO-RLS與P-RLS；根據進入左心房的微泡數量將RLS半定量劃分為3箇等級：1級為少量微泡進入左心房（1~10箇微泡/幀圖像）；2級為中量微泡進入左心房（11~30箇微泡/幀圖像）；3級為大量微泡進入左心房（＞30箇微泡/幀圖像）。對以下幾箇方麵進行觀測和統計分析：（1）健康成年人PFO的髮生率、大小及RLS檢齣率；（2）健康成年人是否存在P-RLS及其檢齣率；（3）RLS與Valsalva動作的關繫；（4）不同起源RLS的半定量分級比較。結果42名健康誌願者中， TEE診斷PFO 13名（13/42，30%），PFO寬（1.46±0.18）mm（1~3 mm），長（7.23±1.09）mm （4~14 mm）。cTTE檢齣RLS共30名（30/42，71%），其中4名同時存在PFO-RLS和P-RSL， PFO-RLS為12名（12/42，29%），P-RLS為22名（22/42，52%）。除1名受檢者外，PFO-RLS的檢齣均與Valsalva動作有關，PFO-RLS多齣現在Valsalva動作結束的瞬間；而P-RLS多齣現在靜息狀態下（14名），部分齣現在Valsalva動作後（8名）。不同來源RLS檢齣率的差異有統計學意義（χ2=4.941， P=0.026）。TEE診斷PFO與cTTE檢齣PFO-RLS一緻者共11名。有2名TEE診斷PFO，但cTTE未檢齣PFO-RLS；有1名cTTE檢齣PFO-RLS，但TEE未診斷PFO。PFO-RLS與P-RLS半定量分級的差異有統計學意義（Z=-3.901，P=0.000）。在12名PFO-RLS中，2級和3級各有6名；在22名P-RLS中，1級11名，2級10名，3級僅1名。結論 PFO及其伴隨的暫短微量RLS在健康成年人群中檢齣率約為1/4，PFO-RLS的檢齣必鬚輔以Valsalva動作。在健康人群中存在著半定量分級相對PFO-RLS較低的P-RLS，其檢齣率、影響因素及其臨床意義尚待更多研究。
목적：료해건강인란원공미폐（PFO）우향좌분류（RLS）화（혹）래원우폐부적RLS（P-RLS）적검출솔。방법수궤선취건강성년지원자42명，진행경식관초성심동도（TEE）화경흉초성심동도（TTE）상규검사。령외，분별재정식상태화Valsalva동작과정중상지정맥쾌속주입수진0.9%록화납용액10 ml，진행경흉초성심동도우심조영（cTTE），근거우심현영후좌심방미포출현적시간구분래PFO-RLS여P-RLS；근거진입좌심방적미포수량장RLS반정량화분위3개등급：1급위소량미포진입좌심방（1~10개미포/정도상）；2급위중량미포진입좌심방（11~30개미포/정도상）；3급위대량미포진입좌심방（＞30개미포/정도상）。대이하궤개방면진행관측화통계분석：（1）건강성년인PFO적발생솔、대소급RLS검출솔；（2）건강성년인시부존재P-RLS급기검출솔；（3）RLS여Valsalva동작적관계；（4）불동기원RLS적반정량분급비교。결과42명건강지원자중， TEE진단PFO 13명（13/42，30%），PFO관（1.46±0.18）mm（1~3 mm），장（7.23±1.09）mm （4~14 mm）。cTTE검출RLS공30명（30/42，71%），기중4명동시존재PFO-RLS화P-RSL， PFO-RLS위12명（12/42，29%），P-RLS위22명（22/42，52%）。제1명수검자외，PFO-RLS적검출균여Valsalva동작유관，PFO-RLS다출현재Valsalva동작결속적순간；이P-RLS다출현재정식상태하（14명），부분출현재Valsalva동작후（8명）。불동래원RLS검출솔적차이유통계학의의（χ2=4.941， P=0.026）。TEE진단PFO여cTTE검출PFO-RLS일치자공11명。유2명TEE진단PFO，단cTTE미검출PFO-RLS；유1명cTTE검출PFO-RLS，단TEE미진단PFO。PFO-RLS여P-RLS반정량분급적차이유통계학의의（Z=-3.901，P=0.000）。재12명PFO-RLS중，2급화3급각유6명；재22명P-RLS중，1급11명，2급10명，3급부1명。결론 PFO급기반수적잠단미량RLS재건강성년인군중검출솔약위1/4，PFO-RLS적검출필수보이Valsalva동작。재건강인군중존재착반정량분급상대PFO-RLS교저적P-RLS，기검출솔、영향인소급기림상의의상대경다연구。
Objective To explore the incidence of the right to left shunt (RLS) originated from patent foramen ovale (PFO) and/or pulmonary (PFO-RLS and/or P-RLS). Methods The transoesophageal echocardiography (TEE) and contrast transthoracic echocardiography (cTTE) were performed in 42 consecutive healthy adults. An agitated saline solution was used as contrast agent. According to the time that microbubbles (MB) occurred in the left atrium within or beyond the ifrst 3 cardiac cycles after contrast appearance in the right atrium, the RLS was identiifed as PFO-RLS or P-RLS. The RLS were semi-quantitated and graded in a three-level categorization according to the number of MB appearanced in the left atrium in every single frame image:level 1 indicated ≤10 MB, namely mild RLS;level 2 indicated 11-30 MB, namely moderate RLS and level 3 indicated>30 MB, namely severe RLS. The reseach mainly focused on:(1) How many PFO and PFO-RLS existed in healthy adults? What was the size of PFO in healthy adults ? (2) Was there any P-RLS could be detected in healthy adults and what was the incidence of P-RLS ? (3) Was there any relationship between the RLS and Valsalva maneuver ? (4) The semi-quantitation and grading of the RLS originated from different sources. Results In 42 healthy adults, 13 cases (13/42, 30%) were diagnosed as PFO by TEE. The width of PFO was (1.46±0.18) mm (1-3 mm) and the length of PFO was (7.23±1.09) mm (4-14 mm). In 42 healthy adults, 30 cases (30/42, 71%) were diagnosed as RLS by cTTE. In 4 cases, the RLS were originated both from PFO and pulmanory, so ifnally there were 12 PFO-RLS (12/42, 29%) and 22 P-RLS (22/42, 52%). Most of PFO-RLS occurred during Valsalva maneuver, especially at the end of Valsalva maneuver, except 1 case in which PFO-RLS occurred at rest condition. Most of P-RLS occurred during rest condition (14) and few occurred after Valsalva maneuver (8). The incidence of PFO-RLS was lower than that of P-RLS. The difference between the two incidences was signiifcant (χ2=4.941, P=0.026). The diagnose for PFO was consistent in 11 cases between TEE and cTTE. But 2 cases were only diagnosed as PFO by TEE and 1 case were only diagnosed as PFO-RLS by cTTE. The semi-quantiifcation grading of RLS was signiifcant different between PFO-RLS and P-RLS (Z=-3.901, P=0.000). In 12 PFO-RLS, there were 6 cases in level 2 and 6 cases in level 3. In 22 P-RLS, there were 11 cases in level 1, 10 cases in level 2 and 1 case in level 3. Conclusions In healthy adults, PFO with a small amount RLS is common and its incidence is about a quarter. The detecting of PFO-RLS must be supplemented by a valsalva maneuve. In healthy adults, the P-RLS is also common and its semi-quantiifcation grading is lower than that of the PFO-RLS. The incidence, detecting inlfuence factor and the clinical signiifcant of the P-RLS are still not very clear and need more study.