经胸超声心动图右心声学造影在“反常栓塞”卵圆孔未闭封堵治疗中的临床应用  

Clinical application of contrast-enhanced transthoracic echocardiography in the occlusion of patent foramen ovale combined with paradoxical embolism

作　　者：王凤霞[1] 许中兴[1] 陶静[1] 王霆 燕建锋 李国庆[1] Wang Fengxia;Xu Zhongxing;Tao Jing;Wang Ting;Yan Jianfeng;Li Guoqing(Xinjiang Uygur Autonomous Region People's Hospital,Urumqi 830000,China)

机构地区：[1]新疆维吾尔自治区人民医院,乌鲁木齐830000

出　　处：《心脑血管病防治》2021年第5期476-479,共4页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

基　　金：新疆维吾尔自治区人民医院院内项目(20190211)。

摘　　要：目的探讨经胸超声心动图右心声学造影(cTTE)在“反常栓塞”卵圆孔未闭(PFO)患者封堵治疗中的临床应用。方法收集2017年12月至2019年11月于新疆维吾尔自治区人民医院心血管内科收治的10例行PFO封堵术患者资料。所有患者均因反复发作的不明原因缺血性脑卒中于神经内科就诊,排除血管性及神经性原因,经由cTTE诊断为PFO合并反常栓塞。分析cTTE结果、PFO封堵术成功率及术中并发症发生情况。采用头痛影响测验-6(HIT-6)对偏头痛患者进行评价,观察治疗效果。结果cTTE共检出右向左分流(RLS)Ⅰ级1例,Ⅱ级4例,Ⅲ级5例。10例患者均成功行PFO封堵术,共发生并发症2例,分别为急性血栓及心包积液各1例,经积极处理均治愈。在术后3 d及术后1个月、术后3个月分别行cTTE检查,仅1例患者在术后3个月的cTTE显示仍有残余RLS分流;所有患者均未再发缺血性脑卒中,亦无短暂性脑缺血发作、心肌梗死等情况发生。术前合并偏头痛的6例患者,在术后1个月偏头痛症状明显改善,HIT-6评分术后1个月较术前、术后3个月较术后1个月均明显降低,差异有统计学意义(t=6.158、5.357,P<0.01)。结论cTTE可有效诊断PFO-RLS及其分流情况,为PFO封堵术的成功实施提供了良好的条件。Objective To explore the clinical application of contrast-enhanced transthoracic echocardiography(cTTE) in the occlusion treatment for patients with patent foramen ovale(PFO)combined with paradoxical embolism. Methods 10 cases of PFO with paradoxical embolism in cardiovascular department of Xinjiang Uygur Autonomous Region People’s Hospital from December 2017 to November 2019 were collected. All patients were treated in neurology department for recurrent ischemic stroke of unknown cause, excluding vascular and neurological causes, and were diagnosed as PFO combined with paradoxical embolism by cTTE. The results of cTTE, the success rate of PFO occlusion and the occurrence of intraoperative complications were analyzed. The patients with migraine were evaluated with headache impact test-6 and the therapeutic effect was observed. Results 1 case of right-to-left shunt(RLS) level Ⅰ, 4 cases of level Ⅱ and 5 cases of level Ⅲ were detected in cTTE. PFO occlusion was successfully performed in all 10 patients, and 2 patients had complications,including 1 case of acute thrombus and 1 case of pericardial effusion, both of them were cured by active treatment. The cTTE was respectively performed 3 days after operation, one month after operation and three months after operation, only one patient showed residual RLS shunt at three months after operation.All patients did not have ischemic stroke, transient ischemic attack or myocardial infarction. Migraine symptoms improved significantly 1 month after surgery. The score of HIT-6 at 1 month after surgery was significantly lower than preoperative, and the score of HIT-6 at 3 months after surgery was significantly lower than that at 1 month after surgery, and the differences were statistically significant(t=6.158, 5.357;P < 0.01). Conclusion cTTE can effectively diagnose PFO-RLS and its shunt status, which provides a good condition for the successful implementation of PFO occlusion.

关 键 词：经胸超声心动图右心声学造影 反常栓塞 卵圆孔未闭 封堵术 

分 类 号：R651.12[医药卫生—外科学]