下腔静脉按压同步改良Valsalva动作对卵圆孔未闭的应用价值

Application value of inferior vena cava compression combined with modified Valsalva maneuver in patent foramen ovale

目的对比分析传统Valsalva动作(Valsalva maneuver,VM)、改良Valsalva动作(modified Valsalva maneuver,mVM)、下腔静脉按压同步改良Valsalva动作(compression of inferior vena cava combined with modified Valsalva maneuver,CM)对卵圆孔未闭的诊断价值以及右向左分流程度的影响,明确CM对卵圆孔未闭的应用价值。方法前瞻性纳入2021年1-12月深圳市龙岗区人民医院偏头痛、头晕、胸痛等症状患者132例,均行安静状态下、传统VM、mVM、CM等辅助动作后,对比分析卵圆孔未闭的检出率以及右向左分流程度。结果采用辅助动作后卵圆孔未闭的检出率明显提高(88.6%比59.8%),差异有统计学意义(χ2=36.026,P<0.001)。对右向左分流的程度,三种不同辅助动作的检出结果差异有统计学意义(χ2=25.581,P<0.001);CM辅助动作最有助于大量右向左分流的检出,与VM、mVM比较,差异有统计学意义(P<0.001,P=0.002)。结论辅助动作对卵圆孔未闭诊断至关重要,相比于VM、mVM,采用CM后更有助于提高卵圆孔未闭的检出率以及判断右向左分流程度。

Objective To comparatively analyze the diagnostic value of patent foramen ovale and the degree of right-to-left shunt among the traditional Valsalva maneuver(VM),the modified Valsalva maneuver(mVM)and the compression of the inferior vena cava combined with modified Valsalva maneuver(CM).Methods A total of 132 patients with migraine,dizziness,chest pain and other symptoms in Longgang District People′s Hospital of Shenzhen from January 2021 to December 2021 were prospectively enrolled.The detection rate of patent foramen ovale and the degree of right-to-left shunt were assessed among the rest state and after performing the auxiliary maneuvers including VM,mVM and CM respectively.Results After performing the auxiliary maneuvers,the detection rate of patent foramen ovale was significantly increased(88.6%vs 59.8%)with statistical significance(χ2=36.026,P<0.001).There was a significant difference in the degree of right-to-left shunt among the three auxiliary maneuvers(χ2=25.581,P<0.001).CM was the most effective for the detection of the large right-to-left shunt,and the difference was statistically significant compared with VM and mVM(P<0.001,P=0.002).Conclusions Auxiliary maneuvers is crucial for the diagnosis of patent foramen ovale.Compared with VM and mVM,performing CM can further improve the detection rate of patent foramen ovale and increase the degree of right-to-left shunt.