CAJ | 학술논문

目的：比较经食管超声心动图（TEE）造影和经胸超声心动图（TTE）造影对卵圆孔未闭（PFO）右向左分流（RLS）的检出效果。方法随机选取不明原因脑卒中或偏头痛伴PFO患者29例。所有患者均先、后进行了TEE和TTE造影，TTE造影探头频率为二次谐波1.7 MHz/3.4 MHz。TEE造影探头频率为7 MHz。通过肘前静脉快速注入手振0.9%氯化钠溶液10 ml进行造影，观察记录右心房充分显影后前3个心动周期内有无微泡进入左心房，根据进入左心房的微泡数量将PFO-RLS划分为4个等级：1级为无RLS，即未见微泡进入左心房；2级为少量RLS，即左心房内可见1~10个微泡/帧；3级为中量RLS，即左心房内可见11~30个微泡/帧；4级为大量RLS，即左心房内可见＞30个/帧，或左心房充满微泡。结果 TTE造影和TEE造影对PFO-RLS的检出率分别为86.2%（25/29）、55.2%（16/29）。对2种方法的检出率进一步作配对χ2检验，结果表明差异有统计学意义（χ2=5.711，P=0.017）。TTE造影半定量分级：1级（无RLS）4例；2级（少量RLS）1例；3级（中量RLS）5例；4级（大量RLS）19例。TEE造影半定量分级：1级（无RLS）13例；2级（少量RLS）3例；3级（中量RLS）6例；4级（大量RLS）7例。对PFO-RLS半定量分级的Wilcoxon检验显示，2种技术所得结果的差异有统计学意义（Z=-3.789，P=0.000）。结论 TTE造影对PFO-RLS的检出效率优于TEE造影。以前者替代后者不但便于相关工作的开展，还可能减少和（或）避免经食管超声检查带来的不适和并发症。
목적：비교경식관초성심동도（TEE）조영화경흉초성심동도（TTE）조영대란원공미폐（PFO）우향좌분류（RLS）적검출효과。방법수궤선취불명원인뇌졸중혹편두통반PFO환자29례。소유환자균선、후진행료TEE화TTE조영，TTE조영탐두빈솔위이차해파1.7 MHz/3.4 MHz。TEE조영탐두빈솔위7 MHz。통과주전정맥쾌속주입수진0.9%록화납용액10 ml진행조영，관찰기록우심방충분현영후전3개심동주기내유무미포진입좌심방，근거진입좌심방적미포수량장PFO-RLS화분위4개등급：1급위무RLS，즉미견미포진입좌심방；2급위소량RLS，즉좌심방내가견1~10개미포/정；3급위중량RLS，즉좌심방내가견11~30개미포/정；4급위대량RLS，즉좌심방내가견＞30개/정，혹좌심방충만미포。결과 TTE조영화TEE조영대PFO-RLS적검출솔분별위86.2%（25/29）、55.2%（16/29）。대2충방법적검출솔진일보작배대χ2검험，결과표명차이유통계학의의（χ2=5.711，P=0.017）。TTE조영반정량분급：1급（무RLS）4례；2급（소량RLS）1례；3급（중량RLS）5례；4급（대량RLS）19례。TEE조영반정량분급：1급（무RLS）13례；2급（소량RLS）3례；3급（중량RLS）6례；4급（대량RLS）7례。대PFO-RLS반정량분급적Wilcoxon검험현시，2충기술소득결과적차이유통계학의의（Z=-3.789，P=0.000）。결론 TTE조영대PFO-RLS적검출효솔우우TEE조영。이전자체대후자불단편우상관공작적개전，환가능감소화（혹）피면경식관초성검사대래적불괄화병발증。
Objective To compare the effect of transthoracic contrast echocardiography (cTTE) with transesophageal contrast echocardiography (cTEE) for detecting right to left shunt (RLS) in patients with patent foramen ovale (PFO). Methods The prospective study was conducted in 29 consecutive patients with PFO who suffered from cryptogenic stroke and/or migraine. Contrast echocardiography was performed in all 29 patients. The cTTE was performed using transducer with second harmonic imaging modality (transmitting frequency 1.7 MHz, receiving frequency 3.4 MHz). The cTEE was performed using transducer with frequency 7 MHz. Ten milliliter saline solution of contrast were rapidly administrated through an antecubital vein. According to whether microbubble (MB) appearing in left atrium after complete opaciifcation of right atrium within the ifrst 3 circles, the results were classiifed by a four-level semi-quantitative categorization:Level 1 (no PFO-RSL), no MB in left atrium; Level 2 (small PFO-RSL) 1-10 MBs; Level 3 (medium PFO-RSL) 10-30 MBs;Level 4 (large PFO-RSL)>30 MBs. Results The total detection rate of PFO-RSL was signiifcant different between cTTE and cTEE (86.2%vs 55.2%,χ2=5.711, P=0.017). In cTTE there were 4 cases at level 1, 1 case at level 2, 5 cases at level 3 and 19 cases at level 4. In cTEE there were 13 cases at leverl 1, 2 cases at level 2, 6 cases at level 3 and 7 cases at level 4. The comparison of semi-quantitative grading derived from cTTE and cTEE was also signiifcant different (Wilcoxon signed ranks test showed Z=-3.789, P=0.000). Conclusions The efifciency in detection of PFO-RLS with cTTE was better than with cTEE. Compared with cTEE, cTTE was easier in practice and brought less discomfort and complications to patients.