c-TCD检测两侧大脑中动脉诊断右向左分流差异的对比研究  

A comparative study of disparity in diagnosing right-to-left shunt in middle cerebral arteries in both sides of brain by c-TCD detection

作　　者：黄钲翔 黄何西 邹晓霄 黎彬如[1] 罗纯[1] HUANG Zhengxiang;HUANG Hexi;ZOU Xiaoxiao;LI Binru;LUO Chun(Department of Neurology,Ethnic Hospital of Guangxi Zhuang Autonomous Region,Nanning 530001,Guangxi,China)

机构地区：[1]广西壮族自治区民族医院神经内科,广西南宁530001

出　　处：《右江医学》2022年第7期521-526,共6页Chinese Youjiang Medical Journal

基　　金：崇左市科技计划项目(崇科攻2019009)。

摘　　要：目的研究经颞窗探测下对两侧大脑中动脉(middle cerebral artery,MCA)进行对比增强经颅多普勒超声(contrast-enhanced transcranial Doppler,c-TCD)检测卵圆孔未闭-右向左分流(patent formen ovale-right to left shunt,PFO-RLS)的检出率及分流量大小的差异,为临床检查目标血管的选择提供更好的依据。方法选取2019年4月—2020年4月在广西民族医院就诊接受c-TCD检查的患者作为研究对象,有偏头痛、短暂性脑缺血发作或隐源性卒中病史,排除经CT血管成像或磁共振血管成像等检查发现颈动脉狭窄的患者,最终纳入研究共220例,均进行左右两侧MCA的同步颞窗探测,并分别在静息状态与改良Valsalva动作下进行。最后对比经颞窗探测的两侧MCA对于PFO-RLS的检出率与分流量差异,根据所得数据分析经颞窗探测的两侧MCA对诊断PFO-RLS的价值。结果220例检查者中PFO-RLS阴性139例,PFO-RLS阳性81例,RLS的发生率为36.82%。81例PFO-RLS阳性患者中,潜在型PFO-RLS 49例,占比60.5%,固有型PFO-RLS 32例,占比39.5%。PFO-RLS分流量:左MCA探测结果小量16例,中量8例,大量51例。右MCA探测结果小量19例,中量7例,大量51例,大量分流例数占比最大,达67.1%。结论(1)c-TCD经颞窗探测下,左右MCA的检出率及分流量的差异不大。除外已明确有颈动脉系统狭窄或闭塞的情况,选择任何一侧MCA进行c-TCD颞窗检查,并不会带来结果上的显著差异。(2)偏头痛、隐源性卒中、短暂性脑缺血发作患病人群中,PFO-RLS发生率比正常人群高,其中少量、中等量分流例数较少,大量分流较多。相比固有型分流,潜在型分流占多数,改良Valsalva动作对PFO检查有重要意义。Objective To study the difference in the detection rate and shunt volume of patent foramen ovale-right-to-left shunt(PFO-RLS)in contrast-enhanced transcranial Doppler(c-TCD)detection of middle cerebral arteries(MCAs)on both sides through temporal window,so as to provide a better basis for the selection of target vessels in clinical examination.Methods Patients receiving the c-TCD examination in Ethnic Hospital of Guangxi Zhuang Autonomous Region from April 2019 to April 2020 were selected as research objects.They had a history of migraines,transient ischemic attack(TIA),or cryptogenic stroke(CS).Patients with carotid artery stenosis found by CT angiography,magnetic resonance angiography,or other examinations were excluded.A total of 220 cases were included in the study.The simultaneous temporal window detection was carried out on the left and right sides of MCA under resting state and modified Valsalva action,respectively.Finally,the detection rate and shunt volume of MCA on both sides in the PFO-RLS detection through the temporal window were compared,and the value of MCA on both sides detected through the temporal window for the diagnosis of PFO-RLS was analyzed according to the data obtained.Results Among the 220 patients examined in this group,PFO-RLS was negative for 139 patients,PFO-RLS was positive for 81 patients,and the incidence of RLS was 36.82%.Among 81 patients whose PFO-RLS was positive,49 patients had potential PFO-RLS,accounting for 60.5%,and 32 patients had inherent PFO-RLS,accounting for 39.5%.Shunt volume of PFO-RLS:the detection result of the left MCA showed that 16 patients had small shunt volume,8 patients had medium shunt volume,and 51 patients had big shunt volume.The detection result of the right MCA showed that 19 patients had small shunt volume,7 patients had medium shunt volume,and 51 patients had big shunt volume.Cases with big shunt volume had the biggest proportion,which was up to 67.1%.Conclusion(1)With the c-TCD detection through the temporal window,there is no significant differen

关 键 词：对比增强 经颅多普勒超声 颞窗探测 卵圆孔未闭 右向左分流 

分 类 号：R445.1[医药卫生—影像医学与核医学]