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目的比较生理盐水-气体混合液(AS)和生理盐水-气体-血混合液(ASb)这两种造影剂在经颅多普勒超声(c-TCD)诊断卵圆孔未闭(PFO)方面的差异。方法收集2015年11月~2016年1月在我院TCD室行c-TCD检查患者248例,通过掷硬币法决定AS或ASb这两种造影剂使用的先后顺序。然后分别均在不伴Valsalva动作(VM)与伴VM情况下,注入造影剂(CA),通过观察TCD频谱,记录CA注射后25 s内微泡数目及第一个微泡出现的时间。具体操作方法如下:(1)9 m L生理盐水混合1 m L空气不伴VM(AS不伴VM);(2)9 m L生理盐水混合1 m L空气伴VM(AS伴VM);(3)9 m L生理盐水、1滴患者回抽血液混合1 m L空气不伴VM(ASb不伴VM);(4)9 m L生理盐水、1滴患者回抽血液混合1 m L空气伴VM(ASb伴VM)。上述每种方法重复2次,且每个过程间隔至少5 min。根据微泡数量对PFO分流程度进行分级:0级,阴性;Ⅰ级,1~10个微泡;Ⅱ级,>10个微泡但未形成“雨帘”;Ⅲ级,形成雨帘状。结果 AS不伴VM、AS伴VM、ASb不伴VM和ASb伴VM检查的阳性率分别是10.9%、23.8%、12.1%、25.8%。AS伴VM组发泡阳性率较AS不伴VM组显著增高,具有统计学差异(23.8%vs 10.9%,P=0.001);ASb伴VM组发泡阳性率较ASb不伴VM组显著增高,具有统计学差异(25.8%vs 12.1%,P=0.001);ASb不伴VM组发泡阳性率与AS不伴VM组相比差异无统计学意义(12.1%vs 10.9%,P=0.250);ASb伴VM组发泡阳性率与AS伴VM组相比差异无统计学意义(25.8%vs 23.8%,P=0.125)。结论应用c-TCD检测PFO时VM能够提高诊断阳性率,而AS与ASb这两种造影剂在诊断PFO阳性率方面无明显差异。
Objective To compare transcranial Doppler sonography (c-TCD) in the diagnosis of patent foramen ovale (PFO) between two contrast media, saline-gas mixture (AS) and saline- gas- The difference. Methods Totally 248 patients underwent c-TCD examination in our TCD room from November 2015 to January 2016. The order of the two contrast agents used as AS or ASb was decided by the coin tossing method. Contrast media (CA) were injected into the Valsalva without VM and VM respectively. The number of microbubbles and the time of the first microbubble within 25 s after CA injection were recorded by observing the TCD spectrum. The specific procedures are as follows: (1) 9 m L saline mixed with 1 m L air without VM (AS without VM); (2) 9 m L saline mixed with 1 m L air with VM (AS with VM); 3) 9 mL saline, one droplet of blood was drawn back into the blood and mixed with 1 mL of air without VM (ASb without VM); (4) 9 mL saline, VM (ASb with VM). Each of the above methods is repeated 2 times with each process being at least 5 min apart. According to the number of microbubbles, the degree of PFO shunting was graded as follows: grade 0, negative; grade 1, 1 to 10 microbubbles; grade II,> 10 microbubbles but did not form “rain curtain”; shape. Results The positive rates of AS without VM, AS with VM, ASb without VM and ASb with VM were 10.9%, 23.8%, 12.1% and 25.8% respectively. The positive rate of foaming in AS with VM group was significantly higher than that in AS without VM group (23.8% vs 10.9%, P = 0.001). The positive rate of foaming in ASb with VM group was significantly higher than that in ASb without VM group (12.8% vs 12.1%, P = 0.001). There was no significant difference in the positive rate of ASb without VM vs those without VM (12.1% vs 10.9%, P = 0.250). There was no significant difference in the positive rate of ASb with VM in VSMCs compared with AS with VMs (25.8% vs 23.8%, P = 0.125). Conclusion The detection of PF by c-TCD can improve the positive rate of diagnosis, while there is no significant difference between the two contrast agents of AS and ASb in the diagnosis of PFO positive rate.