对比增强经颅多普勒评估房间隔膨出瘤患者右向左分流

Evaluation of Right-to-Left Shunt in Patient with Atrial Septal Aneurysm via Contrast-Enhanced Transcranial Doppler

目的探讨对比增强经颅多普勒对房间隔膨出瘤患者心脏水平右向左分流的评估及临床意义。资料与方法回顾性收集2020年6月—2021年7月焦作市人民医院40例房间隔膨出瘤患者和同期242例非膨出瘤患者,均行对比增强经颅多普勒(发泡试验)检查,比较在静息状态下和Valsalva动作后两组右向左分流的总体阳性率;并按监测到的微气泡数量将两组右向左分流进一步分为小量分流和大量分流,比较两组小量分流和大量分流的发生比例,以及Valsalva动作后两组分流量的变化。结果静息状态对比增强多普勒:膨出瘤组右向左分流阳性率高于非膨出瘤组[47.5%(19/40)比29.8%(72/242);χ^(2)=4.95,P=0.03];膨出瘤组小量分流14例(73.7%),大量分流5例(26.3%);非膨出瘤组小量分流61例(84.7%),大量分流11例(15.3%)。静息状态下,两组均以小量分流居多,两组小量和大量的比例差异无统计学意义(χ^(2)=1.26,P=0.264)。Valsalva动作对比增强多普勒:Valsalva动作后两组总体阳性率较静息状态下均显著提高(膨出瘤组77.5%,χ^(2)=8.64,P=0.002;非膨出瘤组48.8%,χ^(2)=80.49,P<0.001);其中大量分流病例数显著增加,膨出瘤组大量分流发生率为64.5%(20/31),非膨出瘤组大量分流发生率为47.5%(56/118),膨出瘤组显著高于非膨出瘤组(χ^(2)=12.58,P<0.001)。结论房间隔膨出瘤患者常伴右向左分流,尤其是Valsalva动作后,对于此类患者,临床上应给予足够的重视,进行规范诊断和治疗。

Purpose To investigate the evaluation value of right-to-left shunt in atrial septal aneurysm(ASA)via contrast-enhanced transcranial Doppler,and analyze its clinical significance.Materials and Methods Forty patients with ASA who were performed on contrast-enhanced transcranial Doppler in Jiaozuo People’s Hospital from June 2020 to July 2021,and 242 patients without ASA during the same period were enrolled.The overall incidence of right-to-left shunt was compared between the two groups in resting state and after Valsalva maneuver.All patients with right-to-left shunt were divided into small shunt group and large shunt group according to the number of microbubbles detected,comparing the incidence of small and big shunt,as well as alterations of shunt after Valsalva maneuver between the two groups.Results Contrast-enhanced transcranial Doppler in resting state:positive rate of ASA patients with right-to-left shunt was significantly higher than that of non-ASA patients via contrast-enhanced transcranial Doppler in resting state[47.5%(19/40)vs.29.8%(72/242);χ^(2)=4.95,P=0.03].There were 14 ASA patients(73.7%)with small shunt and five ASA patients(26.3%)with large shunt.There were 61 non-ASA patients(84.7%)with small shunt and 11 non-ASA patients(15.3%)with large shunt.In resting state,there was no significant difference in ratio between small and large shunts,though there were mainly small shunt patients between the two groups(χ^(2)=1.26,P=0.264).The positive rate of patients with or without ASA were significantly higher after Valsalva maneuver than those in resting state(positive rate of ASA patients was 77.5%,χ^(2)=8.64,P=0.002;positive rate of non-ASA patients was 48.8%,χ^(2)=80.49,P<0.001).The number of cases with massive shunt in ASA group were significantly higher than those in non-ASA group[64.5%(20/31)vs.47.5%(56/118);χ^(2)=12.58,P<0.001].Conclusion ASA is often accompanied by right-to-left shunt,especially those with a substantial right-to-left shunt can trigger by the Valsalva maneuver.Therefore,attention should be paid to patients with ASA in clinical practice with standardized diagnosis and treatment.