Valsalva动作下c-TCD检查在卵圆孔未闭诊断中的应用价值

Application of c-TCD examination under Valsalva maneuver to the diagnosis of patients with patent foramen ovale

目的:探讨Valsalva动作下对比增强经颅多普勒超声(c-TCD)检查在卵圆孔未闭(PFO)诊断中的应用价值。方法:152例隐源性卒中(CS)患者,均行静息和Valsalva动作下c-TCD检查,以经食管超声心动图(TEE)检查结果为"金标准",比较静息状态、Valsalva动作下c-TCD检查诊断PFO的价值,并分析静息状态和Valsalva动作下c-TCD检查评估心脏右向左分流(RLS)的价值。结果:152例CS患者,TEE诊断85例存在PFO。静息状态下c-TCD检查检出PFO 45例,Valsalva动作下c-TCD检查检出PFO 69例;Valsalva动作下c-TCD诊断PFO的灵敏度81.18%、准确度65.13%,分别高于静息状态下c-TCD诊断的52.94%和42.76%,差异有统计学意义(P<0.05);Valsalva动作下c-TCD检查评估RLS级别高于静息状态下c-TCD检查(P<0.05)。结论:Valsalva动作下c-TCD检查CS患者,检出PFD的灵敏度及RIS的级别均高,具有良好应用价值。

Objective: To investigate the value of contrast-enhanced transcranial Doppler ultrasonography(c-TCD)in the diagnosis of patients with patent foramen ovale(PFO)under Valsalva maneuver. Methods: A total of 152 patients with cryptogenic stroke(CS)underwent c-TCD examination under resting and Valsalva maneuver. Taking the results of transesophageal echocardiography(TEE)as the "gold standard", the different values of c-TCD examination in the diagnosis of PFO under the resting state and Valsalva maneuver were compared, and the values of c-TCD examination under the resting state and Valsalva maneuver were analyzed to evaluate the cardiac right-to-left shunt(RLS). Results: Among 152 CS patients, 85 cases were diagnosed with PFO by TEE, 45 cases of PFO were detected by c-TCD examination under resting state, and 69 cases of PFO were detected by c-TCD examination under Valsalva maneuver. The diagnosis sensitivity and accuracy of PFO by c-TCD under Valsalva maneuver was 81.18% and 65.13% respectively, which was higher than the respective 52.94% and 42.76% under the resting state, which was of statistical difference(P<0.05). RLS evaluation level by c-TCD under Valsalva maneuver was higher than that under the resting state(P<0.05). Conclusion: c-TCD examination under Valsalva maneuver has high sensitivity in the diagnosis of PFO in CS patients, and it has good application value in the assessment of RLS level.