房间隔卵圆孔未闭患者右心声学造影表现及其与介入封堵治疗效果的关系  

ASCE performance of PFO patients and the relationship between that and the curative effect of interventional closure

作　　者：罗彦冰 邹秋果[1] 杨暖 张植兰 Luo Yanbing;Zou Qiuguo;Yang Nuan;Zhang Zhilan(Department of Ultrasound Medicine,Haikou People's Hospital,Haikou 570208,China)

机构地区：[1]海口市人民医院超声医学科,海口570208

出　　处：《中国医学装备》2024年第9期76-80,共5页China Medical Equipment

基　　金：海南省自然科学基金面上项目(819MS140)。

摘　　要：目的:探讨房间隔卵圆孔未闭(PFO)患者右心声学造影(ASCE)表现及其与介入封堵术治疗效果的关系。方法:选取2020年10月至2022年8月于海口市人民医院住院治疗的70例房间隔PFO患者,所有患者均行介入封堵术治疗,记录术前、术后ASCE表现及分级情况,并随访12个月,评估有无残余分流;对比术前、术后头痛影响测定-6量表(HIT-6)评分变化。结果:70例PFO患者的ASCE图像特征以及卵圆孔形态中,Ⅰ型22例(占31.42%),卵圆孔直径<1 mm,未闭卵圆孔呈细针样;Ⅱ型28例(占40.00%),卵圆孔直径2~3 mm,未闭卵圆孔呈隧道样;Ⅲ型20例(占28.57%),卵圆孔直径≥3 mm,未闭卵圆孔呈囊袋样。70例患者术后复查ASCE,Ⅰ型、Ⅱ型及Ⅲ型患者封堵器位置良好,与房间隔紧密贴合;所有患者未见残余穿隔血流。术前ASCE右向左(RLS)分级显示,静息RLS0级20例(占28.57%),Ⅰ级25例(占35.71%),Ⅱ级14例(占20.00%),Ⅲ级11例(占15.71%)。瓦氏动作后分级显示,RLSⅠ级30例(占42.85%),Ⅱ级25例(占35.71%),Ⅲ级15例(占21.4%)。术后ASCE的RLS分级显示,所有患者均无RLS,手术前后比较差异有统计学意义(x^(2)=85.783,P<0.05)。70例患者中,ASCE结果显示RLS0级患者的左心房前后径明显小于RLS≥Ⅰ级的患者,差异具有统计学意义(t=8.783,P<0.05)。所有患者术后均未发生出血、感染、血栓栓塞、卒中、封堵器脱落等不良事件。70例患者术前HIT-6评分(73.85±5.79)分,术后1、6个月评分分别降至(50.82±6.57)分和(39.06±4.69)分,术后1个月与6个月HIT-6评分比较差异具有统计学意义(t=3.783,P<0.05)。术后1、6个月复查ASCE结果显示70例患者均无RLS分流现象,经胸超声心动图(TTE)结果显示2例患者存在RLS分流。结论:PFO患者行ASCE,静息状态检查联合瓦氏动作后检查可以明确分流等级,对于术前评估病情及术后判定疗效具有一定参考价值。Objective:To explore the performance of agitated saline contrast echocardiography(ASCE)in patients with patent foramen ovale(PFO)and the relationship of that with the prognosis of treatment of interventional closure.Methods:A total of 70 patients with PFO who were hospitalized in Haikou People's Hospital from October 2020 to August 2022 were selected as research objects.All patients were treated with interventional closure,and the preoperative and postoperative ASCE performances,as well as the ASCE grading were recorded.All patients were followed up for 12 months after operation,and then they were assessed to confirm whether there was any residual diversion.After that,the changes of Headache Impact Test-6 Scale(HIT-6)score between before and after operation were compared.Results:In the ASCE image characteristics and the morphology of the foramen ovale of 70 PFO patients,22 cases(31.42%)were type I patients,whose diameter of the foramen ovale was less than 1 mm,and the patent foramen ovale without closure appeared fine needle-like,and 28 cases(40.00%)were typeⅡpatients,whose diameter of the foramen ovale was between 2 and 3mm,and the patent foramen ovale without closure appeared tunnel-like,and 20 cases(28.57%)were typeⅢpatients,whose diameter of the foramen ovale was≥3mm,and the patent foramen ovale without closure appeared pouch-like.The results of re-examined ASCE of 70 patients indicated that the positions of the occluder were favorable in typeⅠ,ⅡandⅢpatients,which closely attached to the atrial septum.There was not residual blood flow to pass through the atrial septum in all patients.Preoperative ASCE RLS grading showed that 20 cases(28.57%)were rest RLS grade 0,and 25 cases(35.71%)were grade I,and 14 cases(20.00%)were grade II,and 11 cases(15.71%)were grade III.The post classification of Waals maneuver indicated 30 cases(42.85%)were RLS grade I,and 25 cases(35.71%)were RLS grade II,and 15 cases(21.4%)were RLS grade III.Postoperative ASCE RLS grading showed that there was RLS in all patients,and t

关 键 词：房间隔 卵圆孔未闭(PFO) 右心声学造影(ASCE) 介入封堵 

分 类 号：R445.1[医药卫生—影像医学与核医学]