不同体位对对比增强经颅多谱勒超声检测卵圆孔未闭右向左分流的影响

Effects of different body position on contrast enhanced transcranial doppler ultrasound in detecting patent foramen ovale right-to-left shunt

目的探讨不同体位对对比增强经颅多谱勒超声(c TCD)检测卵圆孔未闭(PFO)右向左分流(RLS)的影响。方法对206例缺血性脑血管病患者在平静呼吸时和Valsalva动作后坐位和平卧位下进行c TCD检测。根据微泡数量对RLS分流程度进行分级。Ⅰ级及Ⅰ级以上者为RLS阳性。对RLS阳性者均行对比增强经胸超声心动图(c TTE)、对比增强经食道超声心动图(c TEE)或右心导管检查,验证PFO。结果本组RLS阳性者共86例(41.7%),经c TTE、c TEE或右心导管检查均证实为PFO。平静呼吸时坐位、平卧位的RLS检出率分别为6.8%、6.3%,Valsava动作后坐位、平卧位的RLS检出率分别为38.8%、29.1%。Valsava动作后的RLS检出率显著高于平静呼吸时(均P<0.01)。Valsava动作后坐位的RLS检出率显著高于平卧位时(P<0.05)。结论应用c TCD检测RLS时,坐位结合Valsalva动作有助于提高RLS的检出率。

Objective To observe the effects of different body position on contrast enhanced transcranial doppler ultrasound （cTCD） in detecting patent foramen ovale （PFO） right-to-left shunt （RLS）.Methods Two hundred and six patients with ischemic cerebrovascular disease were detected by cTCD at rest and after Valsalva maneuver in supine and upright sitting.RLS was graded according to the number of the microbubbles.GreadⅠand above were RLS positive. And RLS positive patients were detected by contrast enhanced transthoracic echocardiography （ cTTE ） , contrast enhanced transesophageal echocardiography （ cTEE ） or right cardiac catheterization detection to validate PFO.Results There were 86 RLS positive patients （41.7%） in this group.And which were confirmed as PFO by cTTE, cTEE or right cardiac catheterization detection.At rest, the detection rates of RLS at upright sitting and supine were 6.8%and 6.3%, respectively.After Valsalva maneuver, the detection rates of RLS at upright sitting and supine were 38.8%and 29.1%, respectively.The detection rates of RLS after Valsalva maneuver were significantly higher than those at rest （all P〈0.01）.After Valsalva maneuver, the detection rate of RLS at upright sitting was significantly higher than that at supine （ P〈0.05） .Conclusion When detecting RLS by cTCD, upright sitting combined with Valsalva maneuver is helpful to improve the detection rate of RLS.