CAJ | 학술논문

目的探讨体位对对比经颅多普勒超声(contrast transcranial Doppler,cTCD)检测卵圆孔未闭右向左分流的影响.方法对276例缺血性脑血管病、偏头痛、发作性眩晕、晕厥住院患者于坐位、仰卧位、左侧卧位、右侧卧位应用cTCD检测右向左分流,位置顺序随机分配.根据微泡数量对右向左分流分流程度进行分级:0级,无微泡;Ⅰ级,1～10个微泡;Ⅱ级,＞10个微泡但未形成“雨帘”;Ⅲ级,雨帘形成.同时进行对比经胸超声心动图(contrast transthoracic echocardiography,cTTE)或对比经食管超声心动图(contrast transesophageal echocardiography,cTEE)或右心导管检查.结果 cTCD检查右向左分流的阳性率为48.2％ (133/276),其中82例经cTTE、28例经cTEE、23例经右心导管检查证实为卵圆孔未闭.平静呼吸时各体位的右向左分流检出率及微泡数差异无统计学意义(P ＞0.05);Valsalva动作后各体位的右向左分流检出率及微泡数高于平静呼吸(P ＜0.001),坐位右向左分流检出率及微泡数高于仰卧位、左侧卧位、右侧卧位(P＜0.05).结论应用cTCD检测卵圆孔未闭右向左分流,坐位结合Valsalva动作优于仰卧位、左侧卧位、右侧卧位,采取坐位检测右向左分流有助于提高其检出率及微泡数.
목적 탐토체위대대비경로다보륵초성(contrast transcranial Doppler,cTCD)검측란원공미폐우향좌분류적영향.방법 대276례결혈성뇌혈관병、편두통、발작성현훈、훈궐주원환자우좌위、앙와위、좌측와위、우측와위응용cTCD검측우향좌분류,위치순서수궤분배.근거미포수량대우향좌분류분류정도진행분급:0급,무미포;Ⅰ급,1～10개미포;Ⅱ급,＞10개미포단미형성“우렴”;Ⅲ급,우렴형성.동시진행대비경흉초성심동도(contrast transthoracic echocardiography,cTTE)혹대비경식관초성심동도(contrast transesophageal echocardiography,cTEE)혹우심도관검사.결과 cTCD검사우향좌분류적양성솔위48.2％ (133/276),기중82례경cTTE、28례경cTEE、23례경우심도관검사증실위란원공미폐.평정호흡시각체위적우향좌분류검출솔급미포수차이무통계학의의(P ＞0.05);Valsalva동작후각체위적우향좌분류검출솔급미포수고우평정호흡(P ＜0.001),좌위우향좌분류검출솔급미포수고우앙와위、좌측와위、우측와위(P＜0.05).결론 응용cTCD검측란원공미폐우향좌분류,좌위결합Valsalva동작우우앙와위、좌측와위、우측와위,채취좌위검측우향좌분류유조우제고기검출솔급미포수.
Objective To investigate the influence on right-to-left shunt (RLS) of patent foramen ovale with contrast transcranial Dopple (cTCD) in different positions.Methods 276 consecutive patients included ischemic cerebrovascular disease (ICVD),migraine,episodic vertigo and syncope.They underwent cTCD at rest and after Valsalva maneuver in 4 positions:upright sitting,supine,left lateral decubitus and right lateral decubitus,in random order.RLS was graded 0 (no microbubbles detected),1 (1-10microbubbles),2 (＞ 10 microbubbles but no curtain),and 3 (curtain,shower of microbubbles).Meanwhile,each patients was examined by contrast transthoracic echocardiography(cTTE),contrast transesophageal echocardiography (cTEE) or right heart catheterization.Results RLS detection rate was 48.2％ (133/276)through cTCD.They were also confirmed patent foramen ovale by 82 cases in cTTE,28 cases in cTEE,and 23 patients in right heart catheterization.At rest,RLS detection rate and microbubbles of 4 positions had no significant difference (P ＞0.05).After the Valsalva maneuver,RLS detection rate and microbubbles of each position were significantly higher than at rest (P ＜0.001),and the RLS detection rate and microbubbles in upright sitting were higher than that at rest(P ＜0.05).Conclusions RLS is best detected in the upright sitting position with Valsalva maneuver with cTCD.Upright sitting detection helps to improve the detection rate and microbubbles of RLS.