c-TCD检查对比剂注射时机对脑血流动力学的影响及卵圆孔未闭患者脑血管反应性研究  

Effects of ASb injection timing in contrast-enhanced transcranial Doppler examination on cerebral hemodynamics and cerebrovascular reactivity in patients with patent foramen ovale

作　　者：孔琦 乔松[1] 刘小利[1] 李雅国[1] 赖其伦 姜佩依 KONG Qi;QIAO Song;LIU Xiaoli;LI Yaguo;LAI Qilun;J IANG Peiyi(Department of Neurology,Zhejiang Hospital,Hangzhou 310030,China;不详)

机构地区：[1]浙江医院神经内科,杭州310030

出　　处：《浙江医学》2022年第15期1618-1623,共6页Zhejiang Medical Journal

摘　　要：目的分析Valsava动作(VM)下对比增强经颅多普勒超声(c-TCD)对比剂注射时机对脑血流动力学的影响,并观察卵圆孔未闭(PFO)患者脑血管的反应性。方法选取2020年3月至2021年8月在浙江医院行c-TCD检查的受检者104例,均接受0.9%氯化钠注射液-气体-混血混合液(ASb)3种不同注射时机检查,即无VM常规注射、VM下呼气前注射和VM下呼气后注射。检查结果阳性提示存在心脏右向左分流(RLS),阳性受检者进一步行经食管超声检查明确存在PFO。比较常规注射、呼气前注射、呼气后注射RLS阳性率、微泡信号数量、收缩期血流速度、舒张期血流速度、搏动指数(PI);分析呼气后注射微泡信号数量与大脑中动脉血流速度、PI的相关性;比较阳性组与阴性组受检者大脑中动脉基线流速、峰值流速、屏气指数(BHI)、脑血管反应性受损情况。结果呼气前注射RLS阳性率(51.9%)均高于呼气后注射(42.3%)和常规注射(14.4%),差异均有统计学意义(均P<0.05)。呼气前注射微泡信号数量高于呼气后注射和常规注射(P<0.05),而3种时机注射收缩期血流速度、舒张期血流速度、PI比较差异均无统计学意义(均P>0.05)。呼气后注射微泡数量与收缩期流速、舒张期流速均呈负相关(r=-0.280、-0.328,均P<0.05),而与PI无关(P>0.05)。阳性组54例,阴性组50例,两组受检者基线流速、峰值流速比较差异均无统计学意义(均P>0.05);阳性组BHI低于阴性组,脑血管反应性受损者比例高于阴性组,差异均有统计学差异(均P<0.05)。结论c-TCD检查时在VM期间的呼气前注射ASb可有效提高检查阳性率以及微泡信号数量。PFO患者BHI较正常受检者降低,脑血管反应性受损比例较高。Objective To investigate the effects of agitated saline with blood(ASb)injection timing in contrastenhanced transcranial Doppler(c-TCD)examination on cerebral hemodynamics and cerebrovascular reactivity in patients with patent foramen ovale(PFO).Methods One hundred and four patients undergoing c-TCD examination in Zhejiang Hospital from March 2020 to August 2021 were enrolled in the study.According to the timing of ASb injection patients were divided into 3 groups with 54 cases in each group:in routine group patients received routine ASb injection without Valsava maneuver(VM),in pre-exhalation group ASb was injected before exhalation under VM and in post-exhalation group ASb was injected after exhalation under VM.Each patient was examined at three different injection timing of ASb.The positive results of c-TCD in subjects indicated the presence of cardiac right-to-left shunt(RLS).All subjects in the positive group further underwent transesophageal echocardiography examination to confirm the presence of PFO.RLS positive rate,microbubble signal number,systolic blood flow velocity,diastolic blood flow velocity and resistance index(RI)were compared among 3 groups.The correlation between the number of microbubble signals and middle cerebral artery blood flow velocity and PI in post-exhalation group was analyzed.The baseline flow velocity,peak flow velocity,breath holding index(BHI)and cerebral vascular reactivity impairment were compared between positive group and negative group.Results The positive rate of RLS in pre-exhalation group(51.9%)was higher than that in post-exhalation group(42.3%)and routine group(14.4%)(P<0.05).The number of microbubble signals in pre-exhalation group was higher than that in post-exhalation group and routine group(P<0.05),but there were no significant differences in systolic blood flow velocity,diastolic blood flow velocity and PI among the three groups(all P>0.05).The number of microbubbles in post-exhalation group was negatively correlated with systolic and diastolic velocity(r=-0.280,-

关 键 词：对比增强经颅多普勒超声 Valsava动作 卵圆孔未闭 屏气指数 脑血管反应性 

分 类 号：R743[医药卫生—神经病学与精神病学]