经颅多普勒联合经胸心脏声学造影在军事人员卵圆孔未闭中的诊断价值  

Diagnostic Value of Transcranial Doppler Combined with Contrast Enhanced Transthoracic Echocardiography in Military Personnel with Patent Foramen Ovale

作　　者：范校周 李璐 苏菲菲 吴迪 姚克纯 张龙方 刘禧 Fan Xiaozhou;Li Lu;Su Feifei;Wu Di;Yao Kechun;Zhang Longfang;Liu Xi(Department of Ultrasound,Air Force Medical Center,Air Force Medical University,Beijing 100142,China;Outpatients Department,The Eighth Rest Center for Retired Cadres in Haidian,Beijing Garrison Region,Beijing100195,China;Department of Cardiovasology,Air Force Medical Center,Air Force Medical University,Beijing 100142,China)

机构地区：[1]空军军医大学空军特色医学中心超声诊断科,北京市100142 [2]北京卫戍区海淀第八退休干部休养所门诊部,北京市100195 [3]空军军医大学空军特色医学中心心血管内科,北京市100142

出　　处：《中国超声医学杂志》2023年第4期400-404,共5页Chinese Journal of Ultrasound in Medicine

基　　金：空军军医大学飞行人员作战效能提升航空医学重大问题科技攻关项目(No.2019ZTB05,No.2022ZZXM010);空军特色医学中心科技助推计划项目(No.2020KTB10,No.2022ZTYB14)。

摘　　要：目的探讨经颅超声联合经胸心脏声学造影(cTCCD+cTTE)技术在军事人员卵圆孔未闭(PFO)中的诊断价值。方法以怀疑存在PFO的军事人员作为研究对象,包括16例军事飞行人员和8例一般军事人员,分析cTCCD+cTTE判断PFO有无、静息状态及Valsalva动作下右向左分流(RLS)的情况,并对发现存在RLS的病例进一步行经食管超声心动图(TEE)检查。结果5例临床怀疑PFO的军事飞行人员cTCCD+cTTE检查为阴性;余19例(包括11例军事飞行人员及8例一般军事人员)cTCCD+cTTE法可见PFO-RLS,包括8例常规经胸超声心动图(TTE)检查判定为PFO和11例常规TTE检查未检出PFO的人员。未检出的11例PFO人员中,TEE在8例中可见过隔血流,检出率为72.7%。与cTTE、cTCCD比较,cTCCD+cTTE法在平静状态下检出率较两者均提高15.8%,Valsalva动作下检出率分别提高了5.3%和10.5%,而且固有型比例及中大量分流检出率均有所提高。结论TTE检查在PFO-RLS中灵敏度低,cTCCD+cTTE能够显著提高PFO-RLS的检出率;有效地执行Valsalva动作在判断PFO-RLS中具有重要价值。Objective To investigate the diagnostic value of contrast enhanced transcranial color Doppler combined with contrast enhanced transthoracic echocardiography(cTCCD+cTTE)in patent foramen ovale(PFO)of military personnel.Methods The military personnel suspected with PFO were selected as the research objects,including 16 military pilots and 8 general military personnel.The existence of PFO,occurrence of right-to-left shunt(RLS)under rest and Valsalva maneuver diagnosed by cTCCD+cTTE method were analyzed.Further transesophageal echocardiography(TEE)was performed in the cases with RLS.Results The cTCCD+cTTE results were negative in 5 military pilots suspected of PFO.In the rest 19 cases(including 11 military pilots and 8 general military personnel),PFO-RLS were found by cTCCD+cTTE method,which including the 8 cases who were diagnosed as PFO by conventional TTE examination and 1l cases who were missed by conventional TTE examination.Among the 1l cases of PFO who were missed by conventional TTE,perforating blood flow was detected in 8 cases by TEE method,the detection rate was 72.7%.Compared with the cTTE or cTCCD method,the detection rate of the cTCCD+cTTE method increased 15.8%both under rest condition,increased 5.3%and 10.5%respectively under Valsalva maneuver.Additionally,the proportion of intrinsic PFO and the detection rate of medium/large shunts were increased.Conclusions The TTE method has a low sensitivity in PFO-RLS detection,whereas cTCCD+cTTE method can significantly improve the detection rate of PFO-RLS.Valsalva maneuver executed effectively has great value in PFO-RLS detection.

关 键 词：卵圆孔未闭 军事人员 经颅彩色多普勒超声 经胸超声心动图声学造影 

分 类 号：R445.1[医药卫生—影像医学与核医学] R825.4[医药卫生—诊断学]