肺动静脉畸形右向左分流的对比增强经颅多普勒超声检测特点  

Detecting right-to-left shunt with contrasted transcranial Doppler sonography in patients with pulmonary arteriovenous malformations

作　　者：孙葳[1] 杨敏[1] 要雅君 邢海英[1] 彭清[1] 舒俊龙 门茜 刘冉[1] 许珂[1] 邹英华[1] 黄一宁[1] 

机构地区：[1]北京大学第一医院介入血管外科,100034

出　　处：《中华神经科杂志》2017年第3期195-200,共6页Chinese Journal of Neurology

摘　　要：目的使用对比增强经颅多普勒超声（contrasted transcranial Doppler sonography，cTCD）检测肺动静脉畸形（pulmonary arteriovenous malformation，PAVM）所致右向左分流，并分析其分流特点。方法收集2008-2015年就诊于北京大学第一医院神经内科和介入血管外科的PAVM女性患者8例，均经肺部增强CT、CT血管造影和肺血管造影确诊，患者的血管畸形数目仅为1个者为单发性PAVM，2个或2个以上者为多发性PAVM。总结患者的临床资料，分析cTCD的分流指标，包括平静呼吸和Valsalva动作后微栓子信号（microembolic signals，MES）的出现时间、持续时间和分流量。分流量采用4级分类法确定其分流程度：0级（无分流），无MES；1级（少量分流），单侧大脑中动脉（MCA）出现1～10个MES或双侧MCA出现1～20个MES；2级（中量分流），单侧MCA出现〉10个MES或双侧MCA出现〉20个MES，但未成帘状；3级（大量分流），帘状栓子雨信号，不能在TCD频谱上区分单个MES。持续分流为平静呼吸时存在分流，潜在分流为平静呼吸时无分流、仅在Valsalva动作后出现分流。结果在8例PAVM患者中，有5例为脑梗死，其中1例同时合并肢体动脉栓塞。6例为单发性PAVM，2例为多发性PAVM。MES出现时间为5～11s，MES持续时间为20～60s。中量分流1例，大量分流7例，8例均为持续分流，Valsalva动作后和平静呼吸时相比，各分流指标无明显变化。结论肺部影像学可显示的PAVM的cTCD右向左的分流特点为快速出现的中量至大量分流、持续分流，Valsalva动作后和平静呼吸时相比上述分流特点无明显变化。Objective To investigate the features of right-to-left shunt （RLS） detected by contrasted transcranial Doppler sonography （cTCD） in patients with pulmonary arteriovenous malformation （PAVM）. Methods All medical records of clinical assessment, contrast-enhanced chest CT and CT angiography （CTA）, pulmonary angiography （PA） and cTCD using agitated saline were reviewed of eight patients with PAVM, who admitted to the Department of Neurology and Department of Interventional Radiology and Vascular Surgery of our hospital between 2008 and 2015. The diagnosis of PAVM was confirmed by chest contrast-enhanced CT, CTA and PA in all eight patients. Patients with single pAVM were defined as having a solitary PAVM, while patients with multiple PAVM were defined as having two or more PAVM. Three observation indexes were analyzed to characterize RLS demonstrated by cTCD both during normal respiration and after Valsalva maneuver （VM）, including the time interval for microembolic signals （MES） appearance, MES duration and shunt volume. The degree of shunt volume was graded a four-level categorization of zero through three according to MES count in unilateral middle cerebral artery （MCA） ： （ 1 ） grade 0, no occurrence of MES; （2） grade 1, 1 - 10 MES （or 1 -20 in bilateral MCA） ; （3） grade 2, 〉 10 MES （or 〉20 in bilateral MCA）, but no curtain; （4） grade 3, curtain, where a single MES can not be discriminated within the TCD spectra. Shunt volume was small for grade 1, medium for grade 2, large for grade 3. RLS was considered latent shunt if occurring only after VM and continuous shunt if during normal respiration. Results Among eight patients with PAVM, five patients experienced cerebral infarction and one patient also had artery embolism of her limbs. Six patients had single PAVM and the other two had multiple PAVM. The time interval for MES appearance was 5 - 11 s and MES duration was 20 - 60 s. Shunt volume was large in seven cases and medium in one case. All cases had

关 键 词：动静脉畸形 肺动脉 超声检查 多普勒 经颅 栓塞 反常 回顾性研究 

分 类 号：R543.2[医药卫生—心血管疾病]