非全身麻醉镇静下经食道超声心动图在卵圆孔未闭诊断中的应用价值研究

Application value of transesophageal echocardiography in the diagnosis of patent foramen ovale under sedation of non-general anesthesia

目的探讨非全身麻醉镇静下经食道超声心动图(TEE)在卵圆孔未闭(PFO)诊断中的应用价值。方法选取因不明原因脑卒中、偏头疼来我院就诊,且经颅多普勒发泡试验(c-TCD)筛查结果呈阳性患者181例,将其随机分为普通组(50例)、全麻组(61例)及镇静组(70例),收集其一般资料、TEE一次插管成功率、并发症情况及TEE评估PFO右向左分流(PFO-RLS)分级情况、镇静组患者c-TCD评估PFO-RLS分级情况并比较。结果全麻组及镇静组患者TEE一次插管成功率均高于普通组,并发症发生率明显低于普通组;镇静组TEE一次插管成功率高于全麻组,并发症发生率低于全麻组(P<0.05)。全麻组与镇静组、普通组与镇静组PFO-RLS分级情况均存在显著差异(P<0.05)。镇静组患者TEE对PFO-RLS分级情况的评估与c-TCD具有一致性(Kw=0.686,P<0.01)。结论非全身麻醉镇静下TEE是目前诊断PFO及评估RLS较为理想且易于被患者接受的方式,有助于PFO相关疾病的诊断和治疗,适合在临床推广应用。

Objective To investigate the value of transesophageal echocardiography(TEE)in the diagnosis of patent foramen ovale(PFO)under sedation without general anesthesia.Methods A total of 181 patients with unknown cerebral apoplexy and migraine who came to our hospital and showed positive screening results of contrast-enhanced transcranial Doppler(c-TCD)were selected,and they were randomly divided into normal group(50 cases),general anesthesia group(61 cases)and sedation group(70 cases).General information,success rate of one time intubation by TEE,complications and TEE assesses the grading of PFO right-to-left shunt(PFO-RLS),c-TCD assesses the grading of PFO-RLS were collected and compared.Results The success rate of one time intubation by TEE in general anesthesia group and sedation group was higher than that in normal group,and the complications incidence was significantly lower than that in normal group;the success rate of one time intubation by TEE in sedation group was higher than that in general anesthesia group,and the incidence of complications was lower than that in general anesthesia group(P<0.05).There were significant differences in PFO-RLS grading between general anesthesia group and sedation group,general anesthesia group and sedation group(P<0.05).TEE in the sedation group was consistent with c-TCD in the grading assessment of PFO-RLS(Kw=0.686,P<0.01).Conclusion TEE under sedation with non-general anesthesia is an ideal and easily accepted method for the diagnosis and assessment of PFO and RLS,which is conducive to the diagnosis and treatment of PFO-related diseases and suitable for clinical application.