成人房间隔膨出瘤的超声检查和分类管理策略  

Ultrasonic examination and management of adult atrial septal aneurysm

作　　者：孔学军 王星星 马宁 晋俊平 柴青芬 Kong Xuejun;Wang Xingxing;Ma Ning;Jin Junping;Chai Qingfen(Department of Ultrasound,No.83 Army Hospital,Xinxiang 453000,China;Department of Ultrasound,No.988 Hospital of Joint Logistic Support Force,Zhengzhou 450000,China)

机构地区：[1]陆军第八十三集团军医院超声诊断科,新乡453000 [2]联勤保障部队第九八八医院超声科,郑州450000

出　　处：《中华健康管理学杂志》2021年第5期469-473,共5页Chinese Journal of Health Management

摘　　要：目的探讨成人房间隔膨出瘤(atrial septal aneurysm,ASA)的超声检查和分类管理策略。方法收集2015年1月—2019年10月在陆军第八十三集团军医院及联勤保障部队第九八八医院经胸超声心动图(transthoracic echocardiography,TTE)诊断为ASA的患者138例,其中103例行经食管超声心动图(transesophageal echocardiography,TEE)检查,所有患者行经胸右心声学造影(contrast transthoracic echocardiography,cTTE)检查,按照半定量方法,对分流量进行分级,实施分类管理,进行随访或者接受手术治疗。结果在静息状态下,138例患者中TTE检出ASA合并卵圆孔未闭(patent foramen ovale,PFO)26例,显示左向右分流;在TTE未检出分流的112例患者中,103例行TEE检查,合并PFO者44例,存在左向右分流。TEE检出PFO分流检出率显著高于TTE检查(42.72%比18.84%,P<0.001)。138例患者均行cTTE检查,其中96例(69.56%)存在不同程度的右向左分流,按半定量标准,Ⅰ级15例、Ⅱ级28例、Ⅲ级53例。cTTE对PFO分流检出率显著均高于TTE和TEE检查(69.56%比18.84%和42.72%,均P<0.001)。在96例cTTE检测到右向左分流的患者中临床诊断为隐源性卒中52例(54.17%),其中Ⅰ级6例、Ⅱ级12例、Ⅲ级34例。Ⅱ、Ⅲ级分流接受经导管封堵PFO者新发梗死灶显著低于未接受封堵治疗者(0比27.27%,P=0.011)。结论超声检查结合cTTE对成人ASA合并PFO及右向左分流检出率较高,有助于制定合理的管理策略。Objective To explore the ultrasonography and classification management strategy for adult atrial septal aneurysm(ASA).Methods Of 138 patients diagnosed with ASA by the transthoracic echocardiography(TTE),in No.83 Army Hospital and No.988 Hospital of Joint Logistic Support Force from January 2015 to October 2019,103 underwent the transesophageal echocardiography(TEE),and all were examined by the right heart contrast transthoracic echocardiography(cTTE).According to the semi-quantitative method,the shunt was graded,classified,and managed through follow-up or surgical treatment.Results In the resting state,among 138 patients,26 cases were detected by TTE as ASA with patent foramen ovale(PFO),showing left-to-right shunt.Among 112 patients with no shunt detected by TTE,103 cases underwent TEE,of whom 44 cases had PFO and left-to-right shunt.The detection rate of PFO shunt by TEE was significantly higher than that of TTE(42.72%vs 18.84%,P<0.001).Out of the 138 patients who underwent cTTE,96 cases had different degrees of right-to-left shunt.According to the semi-quantitative standard,there were 15 cases of gradeⅠ,28 cases of gradeⅡ,and 53 cases of gradeⅢ.The detection rate of cTTE was significantly higher than that of TTE and TEE(69.56%vs 18.84%and 42.72%,both P<0.001).Among these 96 patients with right-to-left shunt detected by cTTE,52 cases(54.17%)were clinically diagnosed as cryptogenic stroke,with right-to-left shunt in 6 cases of gradeⅠ,12 cases of gradeⅡ,and 34 cases of gradeⅢ.The number of new infarcts in patients with gradeⅡorⅢshunts who received PFO closure via catheter was significantly lower than that of patients who did not receive closure therapy(0 vs 27.27%,P=0.011).Conclusion ASA combined with PFO and right-to-left shunts were detected more frequently by ultrasonography combined with cTTE in adults,this helps to formulate a reasonable management strategy.

关 键 词：房间隔膨出瘤 卵圆孔 未闭 超声检查 

分 类 号：R541.1[医药卫生—心血管疾病]