经食道心脏超声在心源性栓塞性脑梗死诊断中的应用  

Transoesophageal echocardiography in etiological diagnosis in young patients with cardio-embolic source

作　　者：安荷娣[1] 黄东雅[1] 余飞[1] 刘榕[1] 堵翠[1] 

机构地区：[1]同济大学附属东方医院神经内科,上海200120

出　　处：《中华脑血管病杂志（电子版）》2010年第6期13-16,共4页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

基　　金：浦东新区科委项目(PKJ2009-Y17)

摘　　要：目的评估了经食道心脏超声(TEE)和经胸壁心脏超声(TTE)在心源性栓塞性脑梗死(CES)诊断中的价值。方法收治我院2006年5月至2010年4月的32例隐源性青年脑梗死患者资料。男25例,女7例,年龄19～50岁,平均(38.3±2.8)岁。所有患者均经头颅MRI确诊为急性脑梗死。常规血液生化、心电图、颈动脉超声和头颅MRA检查未发现明显异常(部分患者显示轻度动脉粥样硬化)。32例患者均进行了经胸壁心脏超声(TTE)检查。为进一步明确病因,在局部麻醉下行经食道心脏超声(TEE)检测。结果 32例患者中TEE检出9例(28.1%)CES,TTE检出其中的3例(9.3%)(P<0.05)。其中主动脉部斑块2例,房间隔缺损2例,房间隔瘤1例,卵圆孔未闭1例,左房自发声学显影1例,二尖瓣脱垂1例,二尖瓣增厚1例。两者的主要区别在于对主动脉粥样硬化斑块和房间隔病变的检测。TTE对上述两个部位病变的漏诊分别为2例和3例。TEE和TTE对二尖瓣病变的诊断无明显差别。结论对初步归因于隐源性青年脑梗死患者,建议进一步采用TEE检查。这样可使近1/3的患者发现可能的心源性栓子来源。Objective To evaluate the abnormal echocardiographic findings of transthoracic echocardiography （TTE） / Transoesophageal echocardiography （TEE） in the sehaemic stroke under the age of 50 years. Methods 32 patients aged 19 to 50 years （Mean 38.3 ± 2.8 years） were enrolled in this study, including man 25 cases and female 7 cases. We evaluated all patients who were referred to our university hospital for cryptogenic ischaemic stroke during the period May 2006 to April 2010. All the patients underwent cranial CT/ MRI, doppler sonography, ECG, labolatorial tests, both TTE and TEE. Patients with known preexistent heart disease, such as atrial fibrillation, were excluded. Results Among 32 patients, the possible cardioembolie sources （CES） of 9 cases （ 28.1% ） and 3 cases （9.3 % ） were identified by TEE and TTE, repectively. The difference is significant （ P 〈 0.05 ）. The the abnormal echocardiographic findings include 2 cases of aortic atherosclerotic plaques,2 cases of atrial septal defect （ASD） ,and each one of Patent foramen ovale（ PFO）, atrial septal aneurysm （ASA）, mitral valve prolaps, thickening of the mitral valve, left atrial spontaneous echo contrast. The main difference between the detection of CES with TTE and TEE was present in the detection of Aortic atherosclerotie plaques and atrial septal aneurysms. TTE missed these potential CES in 2 and 3 patients, respectively. Conclusions Our data showed, TEE ist suggested to the patients with initially suspected cryptogeuic stroke. A cardiogenic etiology can eventually be determined in about one third of all patients. This finding may change and modify the approach of therapy and prophylaxis.

关 键 词：脑梗死 心源性栓子来源 经食道心脏超声 

分 类 号：R743.3[医药卫生—神经病学与精神病学]