健康志愿者右心声学造影结果的初步分析  

Preliminary analysis of right heart contrast echocardiography in healthy volunteers

作　　者：李越[1] 刘若卓[2] 翟亚楠[1] 张丽[1] 

机构地区：[1]解放军总医院超声诊断科,北京100853 [2]解放军总医院神经内科,北京100853

出　　处：《中华医学超声杂志（电子版）》2014年第2期37-43,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的了解健康人卵圆孔未闭（PFO）右向左分流（RLS）和（或）来源于肺部的RLS（P—RLS）的检出率。方法随机选取健康成年志愿者42名，进行经食管超声心动图（TEE）和经胸超声心动图（TTE）常规检查。另外，分别在静息状态和Valsalva动作过程中上肢静脉快速注入手振0．9％氯化钠溶液10ml，进行经胸超声心动图右心造影（cTTE），根据右心显影后左心房微泡出现的时间区分来PFO—RLS与P-RLS；根据进入左心房的微泡数量将RLS半定量划分为3个等级：1级为少量微泡进入左心房（1～10个微泡／帧图像）：2级为中量微泡进入左心房（11～30个微泡／帧图像）；3级为大量微泡进入左心房（〉30个微泡／帧图像）。对以下几个方面进行观测和统计分析：（1）健康成年人PFO的发生率、大小及RLS检出率；（2）健康成年人是否存在P-RLS及其检出率：（3）RLS与Valsalva动作的关系；（4）不同起源RLS的半定量分级比较。结果42名健康志愿者中，TEE诊断PFO13名（13／42，30％），PFO宽（1．46±0．18）mm（1-3mm），长（7．23±1．09）mm（4-14mm）。cTTE检出RLS共30名（30／42，71％），其中4名同时存在PFO．RLS和P-RSL，PFO-RLS为12名（12／42，29％），P—RLS为22名（22／42，52％）。除1名受检者外，PFO．RLS的检出均与Valsalva动作有关，PFO-RLS多出现在Valsalva动作结束的瞬间；而P-RLS多出现在静息状态下（14名），部分出现在Valsalva动作后（8名）。不同来源RLS检出率的差异有统计学意义（χ2=4．941，P=0．026）。TEE诊断PFO与cTTE检出PFO-RLS一致者共11名。有2名TEE诊断PFO，但cTTE未检出PFO-RLS；有1名cTTE检出PFO-RLS，但TEE未诊断PFO。PFO-RLS与P-RLS半定量分级的差异有统计学意义（Z=-3．901，P=0．000）。在12名PFO-RLS中，2级和3级各有6名；在22名P-RLS中，1级11名，2级10名，3级仅1名。结论PFO及其伴随的暂短微量RLObjective To explore the incidence of the right to left shunt （RLS） originated from patent foramen ovale （PFO） and/or pulmonary （PFO-RLS and/or P-RLS）. Methods The transoesophageal echocardiography （TEE） and contrast transthoracic echocardiography （cTTE） were performed in 42 consecutive healthy adults. An agitated saline solution was used as contrast agent. According to the time that microbubbles （MB） occurred in the left atrium within or beyond the first 3 cardiac cycles after contrast appearance in the right atrium, the RLS was identified as PFO-RLS or P-RLS. The RLS were semi-quantitated and graded in a three-level categorization according to the number ofMB appearanced in the left atrium in every single frame image： level 1 indicated ≤ 10 MB, namely mild RLS; level 2 indicated 11-30 MB, namely moderate RLS and level 3 indicated 〉 30 MB, namely severe ILLS. The reseach mainly focused on： （1） How many PFO and PFO-RLS existed in healthy adults？ What was the size of PFO in healthy adults ？ （2） Was there any P-RLS could be detected in healthy adults and what was the incidence of P-RLS ？ （3） Was there any relationship between the RLS and Valsalva maneuver ？ （4） The semi-quantitation and grading of the RLS originated from different sources. Results In 42 healthy adults, 13 cases （13/42, 30%） were diagnosed as PFO by TEE. The width of PFO was （1.46±0.18） mm （1-3 mm） and the length of PFO was （7.23±1.09） mm （4-14 mm）. In 42 healthy adults, 30 cases （30/42, 71%） were diagnosed as RLS by cTTE. In 4 cases, the RLS were originated both from PFO and pulmanory, so finally there were 12 PFO-RLS （12/42, 29%） and 22 P-RLS （22/42, 52%）. Most of PFO-RLS occurred during Valsalva maneuver, especially at the end of Valsalva maneuver, except I case in which PFO-RLS occurred at rest condition. Most of P-RLS occurred during rest condition （14） and few occurred after Valsalva maneuver （8）. The incidence of PFO-RLS was lower than that of P-

关 键 词：卵圆孔 未闭 超声心动描记术 造影剂 

分 类 号：R540.45[医药卫生—心血管疾病]