实时三维超声心动图联合右心声学造影对成年人心脏卵圆孔未闭的诊断价值
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摘要
目的:探究实时三维超声心动图(RT-3DE)联合经胸右心声学造影(cTTE)在成年人心脏卵圆孔未闭(PFO)诊断中的价值及临床意义。方法:选取在医院就诊的100例PFO患者,采用数表法随机将其分为观察组和对照组,每组50例。观察组行RT-3DE联合cTTE检查,对照组行单纯cTTE检查;记录两组静息状态及瓦耳萨耳瓦氏手法(Valsalva)动作下检查方式对PFO的位置大小、毗邻关系和对右向左分流(RLS)的分流量的评估,比较分析各项检查的数据,评估RT-3DE联合cTTE的诊断价值。结果:观察组静息状态下检出PFO和Valsalva动作下检出PFO分别为26例和45例,对照组分别为49例和44例,两组比较差异无统计学意义(x~2=0.194,P>0.05)。观察组PFO患者在静息状态下RLS的分流量评估1级15例,2级7例,3级4例;在Valsalva动作下RLS的分流量的评估显示,1级12例,2级13例,3级20例,不同状态下对应分级之间的比较差异有统计学意义(x~2=6.093,x~2=8.244,x~2=9.031,x~2=7.531;P<0.05);观察组对PFO的位置、大小、毗邻关系等的显示情况也优于对照组,其最大径差异有统计学意义(t=19.017,P<0.05)。结论:RT-3DE联合cTTE对成年人心脏PFO患者进行检查,其PFO的位置大小、毗邻关系和RLS的分流量评估效果佳,临床应用RT-3DE联合c TTE检查,有助于成年人卵圆孔的诊断。
Objective:To investigate the value and clinical significance of real-time three-dimensional echocardiography(RT-3DE)combined with right contrast transthoracic echocardiography(CTTE)in diagnosing adult patent with patent foramen ovale(PFO).Methods:One hundred patients with PFO who were admitted to hospital were randomly divided into observation group(50 cases)and control group(50 cases)by using the random number table method.The observation group underwent combined examination of RT-3DE and cTTE,and the control group underwent simple cTTEexamination.The assessments of two examination modes of two groups under the quiescent condition and Valsalva action for position size,adjacent relationship and shunt volume of right-to-left shunt(RLS)were recorded and compared.And the data of each examination were compared and analyzed,and the diagnostic value of RT-3DE combined with cTTE was further assessed.Results:Patients with PFOs were detected under quiescent condition and Valsalva action of observation group were 26 cases and 45 cases,respectively.And that of the control group were 49 cases and 44 cases,respectively.There was no significant difference between the two groups(x~2=0.194,x~2>0.05).In observation group,the results of assessment of shunt volume of RLS of patients with PFO under quiescent condition included I grade(15 cases),II grade(7cases)and III grade(4 cases),and that under Valsalva action included I grade(12 cases),II grade(13 cases)and III grade(20 cases).And the differences of corresponding grades between two conditions were significant(x~2=6.093,x~2=8.244,x~2=9.031,x~2=7.531,P<0.05).Besides,the position,size,adjacent relationship of observation group for PFO were significantly better than those of control group(t=19.017,P<0.05).Conclusion:Assessment effect of RT-3DE combined with cTTE for positional size,adjacent relationship and shunt volume of RLS of adult patients with PFO is better.Clinical application of RT-3DE combined with cTTE examination would contribute to diagnose PFO of adult patients.
Objective:To investigate the value and clinical significance of real-time three-dimensional echocardiography(RT-3DE)combined with right contrast transthoracic echocardiography(CTTE)in diagnosing adult patent with patent foramen ovale(PFO).Methods:One hundred patients with PFO who were admitted to hospital were randomly divided into observation group(50 cases)and control group(50 cases)by using the random number table method.The observation group underwent combined examination of RT-3DE and cTTE,and the control group underwent simple cTTEexamination.The assessments of two examination modes of two groups under the quiescent condition and Valsalva action for position size,adjacent relationship and shunt volume of right-to-left shunt(RLS)were recorded and compared.And the data of each examination were compared and analyzed,and the diagnostic value of RT-3DE combined with cTTE was further assessed.Results:Patients with PFOs were detected under quiescent condition and Valsalva action of observation group were 26 cases and 45 cases,respectively.And that of the control group were 49 cases and 44 cases,respectively.There was no significant difference between the two groups(x~2=0.194,x~2>0.05).In observation group,the results of assessment of shunt volume of RLS of patients with PFO under quiescent condition included I grade(15 cases),II grade(7cases)and III grade(4 cases),and that under Valsalva action included I grade(12 cases),II grade(13 cases)and III grade(20 cases).And the differences of corresponding grades between two conditions were significant(x~2=6.093,x~2=8.244,x~2=9.031,x~2=7.531,P<0.05).Besides,the position,size,adjacent relationship of observation group for PFO were significantly better than those of control group(t=19.017,P<0.05).Conclusion:Assessment effect of RT-3DE combined with cTTE for positional size,adjacent relationship and shunt volume of RLS of adult patients with PFO is better.Clinical application of RT-3DE combined with cTTE examination would contribute to diagnose PFO of adult patients.
引文
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[8]李波,詹晓英,马小静.经胸超声心动图声学造影结合经颅多普勒声学造影在卵圆孔未闭诊断中的应用[J].中华临床医师杂志(电子版),2015(22):1246-4249.
[9]韩军良.赵钢.卵圆孔未闭解剖和检查技术的进展[J].中国卒中杂志,2014,9(7):591-595.
[10]Mcgrath ER,Paikin JS,Motlagh B,et al.Transesophageal echocardiography in patients with cryptogenic ischemic stroke:asystematic review[J].J Am Heart,2014,168(5):706-712.
[11]任群,傅蕴韵,刘彦君,等.右心声学造影联合经食管超声心动图在卵圆孔未闭诊断中的应用价值[J].中国超声医学杂志,2016,32(12)1097-1099.
[12]王英莉,张娜,郭朋悦,等.右心声学造影对卵圆孔未闭右向左分流的检出情况[J].心脏杂志,2016,11(3):323-325.
[2]Kutty S,Sengupta PP,Khandheria BK.Patent foramen ovale:The known and the to be known[J].J Am Coll Cardiol,2012,59(19):1665-1671.
[3]李阳,邓又斌.卵圆孔未闭的超声造影评估及临床意义[J].中华超声影像学杂志,2014,23(7):627-629.
[4]中国医师协会心血管内科分会,卵圆孔未闭处理策略中国专家建议[J].心脏杂志,2015,27(4):373-379.
[5]张隽,邓又斌.卵圆孔未闭的超声评估与治疗研究进展[J].实用医院临床杂志,2016,13(5):39-42.
[6]杜亚娟,张玉顺,成革胜.TTE结合cTTE在卵圆孔未闭介入治疗中的应用[J].心脏杂志,2015,27(4):397-403.
[7]侯传举,邓东安,朱鲜阳,等.彩色多普勒超声心动图与先天性心脏病介入治疗[M].沈阳:辽宁科学技术出版社,2013:302-310.
[8]李波,詹晓英,马小静.经胸超声心动图声学造影结合经颅多普勒声学造影在卵圆孔未闭诊断中的应用[J].中华临床医师杂志(电子版),2015(22):1246-4249.
[9]韩军良.赵钢.卵圆孔未闭解剖和检查技术的进展[J].中国卒中杂志,2014,9(7):591-595.
[10]Mcgrath ER,Paikin JS,Motlagh B,et al.Transesophageal echocardiography in patients with cryptogenic ischemic stroke:asystematic review[J].J Am Heart,2014,168(5):706-712.
[11]任群,傅蕴韵,刘彦君,等.右心声学造影联合经食管超声心动图在卵圆孔未闭诊断中的应用价值[J].中国超声医学杂志,2016,32(12)1097-1099.
[12]王英莉,张娜,郭朋悦,等.右心声学造影对卵圆孔未闭右向左分流的检出情况[J].心脏杂志,2016,11(3):323-325.