右心声学造影对心内由右向左分流的半定量研究

The semiquantitaive study of intracardiac right-to-left shunts by right-sided contrast echocardiography

目的 :探讨右心声学造影对心内由右向左分流半定量诊断的价值。方法 :对 34例先天性心脏病患者 ,经静脉注射声振 5 0 %葡萄糖 ,根据左心显影情况进行半定量分级 :0级 ,造影剂局限于右心显影 ,左心无造影剂反射 ; 级 ,左心有稀疏、范围局限的造影剂反射 ; 级 ,左心有较浓密、范围较大的造影剂反射 ; 级 ,左心腔及流出道充满浓密造影剂 ,其浓密程度与右心相似。穿刺取股动脉血液测定动脉血氧饱和度 (Sa O2 )。结果 :0级 ,平均Sa O2 为 (98.44± 1.10 ) % ; 级 ,平均 Sa O2 为 (98.40± 1.0 4) % ; 级 ,平均 Sa O2 为 (84.31± 1.0 1) % ; 级 ,平均Sa O2 为 (76 .17± 8.0 6 ) %。 0级与 级显影 ,平均 Sa O2 无显著性差异 (P>0 .0 5 ) ; 级与 级显影之间 ,平均Sa O2 有明显差异 (P <0 .0 5 ) ; 级与 级显影 ,平均 Sa O2 亦有显著性差异 (P <0 .0 5 ) ,且左心造影剂越浓密 ,Sa O2 越低。结论 :采用右心声学造影对心内由右向左分流的诊断具有一定意义。根据造影剂在左心显影情况 ,即可大致判定心内由右向左分流程度。

Objective:This paper was designed to investigate the semiquantitative diagnostic value of intracardiac right-to-left shunts by right heart contrast echocardiography.Methods:In 34 patients with congenital heart disease (CHD),contrast echocardiography was performed by sonicated 50% dextrose via peripheral venous injection.A semiquantitative grade was performed according to the visualization degree of left heart: 0 grade,no contrast echoes in the left heart; Ⅰ grade,sparse contrast echoes in the left heart with limited scope; Ⅱ grade, contrast echoes with moderate intensity in the left heart;Ⅲ grade,dense contrast agents in the left heart and almost as much as right heart.Femoral artery blood was sampled for blood oxygen saturation (SaO 2).Results:0 grade,mean SaO 2:( 98.44 ± 1.10 )%;Ⅰ grade,mean SaO 2:( 98.40 ± 1.04 )%; Ⅱ grade,mean SaO 2:( 84.31 ± 1.01 )%;Ⅲ grade,mean SaO 2:( 76.17 ± 8.06 )%.Between 0 and Ⅰ grades,mean SaO 2 was of no significant difference (P> 0.05 ).Between Ⅰ and Ⅱ grades,however mean SaO 2 was of a significant difference (P< 0.05 ). Between Ⅱ and Ⅲ grades,mean SaO 2 was of a significant difference too (P< 0.05 ).Conclusion:It was feasible that the intracardiac right-to-left shunts could be semiquantitatively diagnosed with contrast echocardiography.We might determine the degree of intracardiac right-to-left shunts according to the contrast echoes of left heart.