切换至 "中华医学电子期刊资源库"
高级检索
中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2016, Vol. 13 ›› Issue (03) : 191 -197. doi: 10.3877/cma.j.issn.1672-6448.2016.03.006

所属专题： 文献；

心血管超声影像学

改良右心声学造影与传统右心声学造影对照研究
王胰1, 曾杰2, 李文华1, 邓燕1, 李春梅1, 尹立雪1,†()   
  1. 1. 610072　成都，四川省医学科学院?四川省人民医院超声医学研究所　超声心脏电生理学与生物力学四川省重点实验室
    2. 610072　成都，四川省医学科学院?四川省人民医院心内科
  • 收稿日期:2015-06-26 出版日期:2016-03-01
  • 通信作者: 尹立雪

A comparative study on modified right heart contrast echocardiography and traditional right heart contrast echocardiography

Yi Wang1, Jie Zeng2, Wenhua Li1, Yan Deng1, Chunmei Li1, Lixue Yin1,†()   

  1. 1. Institute of Ultrasound Medicine, Sichuan Academy of Medical Sciences; Sichuan Provincial People′s Hospital, Chengdu 610072, China
    2. Department of Cardiology, Sichuan Academy of Medical Sciences; Sichuan Provincial People′s Hospital, Chengdu 610072, China
  • Received:2015-06-26 Published:2016-03-01
  • Corresponding author: Lixue Yin
  • About author:
    Corresponding author: Yin Lixue, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

王胰, 曾杰, 李文华, 邓燕, 李春梅, 尹立雪. 改良右心声学造影与传统右心声学造影对照研究[J]. 中华医学超声杂志（电子版）, 2016, 13(03): 191-197.

Yi Wang, Jie Zeng, Wenhua Li, Yan Deng, Chunmei Li, Lixue Yin. A comparative study on modified right heart contrast echocardiography and traditional right heart contrast echocardiography[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2016, 13(03): 191-197.

目的

比较改良右心声学造影与传统右心声学造影检测心内或心外右向左分流（RLS）的安全性、稳定性和有效性。

方法

（1）显微镜下检测：2种右心声学造影方法[改良法：8 ml生理盐水（AS）＋1 ml静脉血＋1 ml空气；传统法：9 mlAS＋1ml空气]分别震荡10、20次后（AS10组、AS20组、ASb10组、ASb20组）显微镜下观察产生微泡大小、数目、红细胞形态；（2）临床实验：选取2014年4至12月四川省人民医院门诊及住院患者中临床怀疑有RLS者（隐源性脑卒中、短暂性脑缺血发作、先兆性偏头痛、仰卧呼吸-直立位低氧血症患者）32例。所有患者均采用2种右心声学造影方法分别震荡10、20次进行造影（AS10组、AS20组、ASb10组、ASb20组）。记录患者右心显影时间，观察RLS情况并进行半定量分析；监测患者造影前后血氧饱和度、血清间接胆红素浓度及尿胆原浓度。采用单因素方差分析比较各组产生微泡数目、大小及患者右心显影时间差异，进一步组间两两比较采用LSD-t检验；采用χ2比较各组患者RSL检出率差异，进一步组间两两比较采用χ2分割检验；采用秩和检验比较各组患者RLS半定量分析结果，进一步组间两两比较采用Nemenyi检验；采用配对t检验患者造影前后血氧饱和度、血清间接胆红素浓度及尿胆原浓度差异。

结果

显微镜下观察，震荡次数越多，红细胞膜破坏越明显。ASb20组产生微泡数目最多，约为AS10组的4倍，且差异有统计学意义（t=14.180，P<0.01）；而各组产生微泡大小差异无统计学意义。32例患者中，改良右心声学造影法观测到RLS者22例（22/32，68.8%），传统右心声学造影法观测到RLS者18例（18/32，56.3%）。任意两组患者间RLS半定量分析结果差异均有统计学意义（ASb20组与AS10组、AS20组、ASb10组比较：χ2=13.567、11.646、9.001；Asb10组与AS10组、AS20组比较：χ2=9.125、2.589；AS20组与AS10组比较：χ2=8.127；P均<0.01）。所有患者造影前后血氧饱和度、血清间接胆红素浓度及尿胆原浓度差异均无统计学意义。

结论

改良右心声学造影法是一种安全、稳定、高性价比的检查RSL的方法；改良右心声学造影法RLS的半定量评估及其与临床事件的关系尚需进一步研究。

关键词: 右心声学造影, 微泡, 右向左分流, 卵圆孔未闭
Objective

To compare the safety, stability and effectiveness of modified right heart contrast echocardiography and traditional right heart contrast echocardiography in detection of intra- or extra-cardiac right to left shunt (RLS).

Methods

(1) Microscopic analysis: After agitating 10 times or 20 times (AS10, AS20, ASb10, ASb20), two right heart contrast agent (modified: 8 ml saline+ 1 ml blood+ 1 ml air; traditional: 9 ml saline+ 1 ml air) underwent the microscopic examination to compare the bubble size, bubble number and red blood cell morphology; (2) Clinical experiment: Thirty-two inpatients or outpatients suspected of RLS (cryptogenic stroke, transient ischemic attack, migraine with aura or platypnea-orthodeoxia syndrome) in Sichuan Provincial Hospital were selected. All patients underwent two right heart contrast echocardiography in which contrast agents had been agitated for 10 and 20 times (AS10, AS20, ASb10, ASb20). Monitor the right heart developing time, RLS and the oxygen saturation change were monitored and the RLS were semi-quantitatively analyzed. The indirect bilirubin and urobilinogen change after the contrast echocardiography were compared.

Results

Microscopic analysis showed that red blood cell membrane damaged more seriously as the agitated times increased. ASb20 generated more bubbles and the number of bubbles was about 4 times of that of AS10 generated (t=14.180, P<0.01); but the bubble size difference was not significant. With the modified method, RLS were detected in 22 patients (68.8%, 22/32). With the traditional method, RLS were detected in 18 patients (56.3%, 18/32). The results of semi-quantitative analysis of RLS was significant different between any two groups (ASb20 vs. AS10, AS20, ASb10: χ2=13.567, 11.646 and 9.001, respectively; ASb10 vs. AS10, AS20: χ2=9.125 and 2.589; AS20 vs. AS10: χ2= 8.127; all P<0.01). The change of oxygen saturation, the indirect bilirubin and urobilinogen were not significant after the contrast echocardiography.

Conclusions

Modified right heart contrast echocardiography is a safe, stable and cost-effective method to detect RLS. The semi-quantitative analysis of RLS with modified right heart contrast echocardiography and their relationship with clinical accident needs further research.

Key words: Right heart contrast echocardiography, Microbubble, Right-to-left shunt, Patent foramen ovale
图3~6 显微镜下观察不同右心声学造影法不同震荡次数不同组分造影剂产生微泡大小及数目（×20）。图3　为传统右心声学造影法震荡10次，图4　为传统右心声学造影法震荡20次，图5　为改良右心声学造影法震荡10次，图6　为改良右心声学造影法震荡20次。图6　中微泡数目明显增多，而各组微泡大小无显著差异
表1 不同右心声学造影法不同震荡次数显微镜下观察结果比较（±s）
组别 重复次数 微泡数目（个/低倍镜视野） 微泡大小（μm）
AS10 10 12.00±4.06b 32.00±4.47
AS20 10 23.00±6.39 30.40±4.69
ASb10 10 21.70±7.44 34.20±5.20
ASb20 10 50.30±5.72a 31.10±4.15
F值 ? 74.459 1.265
P值 ? <0.01 >0.05
表2 不同右心声学造影法不同震荡次数显影时间及RLS检出率比较
组别 例数 右心显影时间（s，±s） RLS[例（%）]
AS10 32 8.28±0.99b 5（15.6）c
AS20 32 6.84±1.02 18（56.3）
ASb10 32 6.22±1.01 21（65.6）
ASb20 32 5.59±1.04a 22（68.8）
检验值 ? F=41.081 χ2=23.148
P值 ? <0.01 <0.01
图7~10 同一例患者不同右心声学造影法不同震荡次数对心内或心外右向左分流的检测。图7　为传统右心声学造影法震荡10次，图8　为传统右心声学造影法震荡20次，图9　为改良右心声学造影法震荡10次，图10　为改良右心声学造影法震荡20次。图10　可见大量心内或心外右向左分流充盈左心房，而图7　只见少量心内或心外右向左分流
表3 不同右心声学造影法不同震荡次数RLS半定量分析结果比较（例）
组别 例数 0级 Ⅰ级 Ⅱ级 Ⅲ级
AS10 32 27 5 0 0
AS20c 32 14 15 3 0
ASb10b 32 11 11 10 0
ASb20a 32 10 2 8 12
F值 ? 19.036
P值 ? <0.01
表4 患者造影前后生理参数比较（±s）
时间 例数 血氧饱和度（%） 血清间接胆红素浓度（μmol/L） 尿胆原浓度（μmol/L）
造影前 32 98.47±2.27 15.64±5.03 0.55±0.50
造影后 32 98.28±3.08 15.88±5.03 0.56±0.51
t值 ? 0.556 -1.727 -0.338
P值 ? 0.582 0.094 0.737
[1]
Meissner I Khandheria BK, Heit JA, et al. Patent foramen ovale: innocent or guilty? Evidence from a prospective population-based study [J]. J Am Coll Cardiol, 2006, 47(2): 440-445.
[2]
Dowson A, Mullen MJ, Peatfield R, et al. Migraine Intervention With STARFlex Technology (MIST) trial: a prospective, multicenter, double-blind, sham-controlled trial to evaluate the effectiveness of patent foramen ovale closure with STARFlex septal repair implant to resolve refractory migraine headache [J]. Circulation, 2008, 117(11): 1397-1404.
[3]
de Belder MA, Tourikis L, Leech G, et al. Risk of patent foramen ovale for thromboembolic events in all age groups [J]. Am J Cardiol, 1992, 69(16): 1316-1320.
[4]
Cabanes L, Mas JL, Cohen A, et al. Atrial septal aneurysm and patent foramen ovale as risk factors for cryptogenic stroke in patients less than 55 years of age. A study using transesophageal echocardiography [J]. Stroke, 1993, 24(12): 1865-1873.
[5]
Sastry S, Daly K, Chengodu T, et al. Is transcranial Doppler for the detection of venous-to-arterial circulation shunts reproducible? [J]. Cerebrovasc Dis, 2007, 23(5-6): 424-429.
[6]
Lange MC, Zetola VF, Piovesan EJ, et al. Saline versus saline with blood as a contrast agent for right-to-left shunt diagnosis by transcranial Doppler: is there a significant difference? [J]. J Neuroimaging, 2012, 22(1): 17-20.
[7]
Martinez-Sanchez P, Medina-Baez J, Lara-Lara M, et al. Low sensitivity of the echocardiograph compared with contrast transcranial Doppler in right-to-left shunt [J]. Neurologia, 2012, 27(2): 61-67.
[8]
Droste DW, Lakemeier S, Wichter T, et al. Optimizing the technique of contrast transcranial Doppler ultrasound in the detection of right-to-left shunts [J]. Stroke, 2002, 33(9): 2211-2216.
[9]
Fan S, Nagai T, Luo H, et al. Superiority of the combination of blood and agitated saline for routine contrast enhancement [J]. J Am Soc Echocardiogr, 1999, 12(2): 94-98.
[10]
Marriott K, Manins V, Forshaw A, et al. Detection of right-to-left atrial communication using agitated saline contrast imaging: experience with 1 162 patients and recommendations for echocardiography [J]. J Am Soc Echocardiogr, 2013, 26(1): 96-102.
[11]
Vallurupalli S, Lodha A, Kupfer Y, et al. Platypnea-Orthodeoxia syndrome after repair of a paraesophageal hernia [J]. BMJ Case Rep, 2013.
[12]
Choi DY, Shin DH, Cho KH, et al. Migraine with aura: a predictor of patent foramen ovale in children and adolescents [J]. Cephalalgia, 2013, 33(7): 463-468.
[13]
Takagi H, Umemoto T; ALICE (All-Literature Investigation of Cardiovascular Evidence) Group. A meta-analysis of case-control studies of the association of migraine and patent foramen ovale [J]. J Cardiol, 2015. [Epub ahead of print]
[14]
Homma S, Sacco RL, Di Tullio MR, et al. Effect of medical treatment in stroke patients with patent foramen ovale: patent foramen ovale in Cryptogenic Stroke Study [J]. Circulation, 2002, 105(22): 2625-2631.
[15]
Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association [J]. Stroke, 2014, 45(7): 2160-2236.
[16]
中国医师协会心血管内科医师分会. 卵圆孔未闭处理策略中国专家建议 [J]. 心脏杂志, 2015, 4: 372-379.
[17]
李越, 刘若卓, 翟亚楠, 等. 健康志愿者右心声学造影结果的初步分析 [J/CD]. 中华医学超声杂志:电子版, 2014, 11(2): 135-141.
[18]
Zhao E, Wei Y, Zhang Y, et al. A Comparison of Transthroracic Echocardiograpy and Transcranial Doppler With Contrast Agent for Detection of Patent Foramen Ovale With or Without the Valsalva Maneuver [J]. Medicine (Baltimore), 2015, 94(43): e1937.
[1] 赵敏, 施依璐, 段莎莎, 王雅皙, 赵捷, 赵海玥, 张璐, 白天昊, 张小杉. RGD微泡介导高频超声造影对类风湿性关节炎滑膜新生血管的定量评估[J]. 中华医学超声杂志（电子版）, 2023, 20(05): 530-536.
[2] 张笛, 李贞茂, 尹立雪, 周超, 雷蕾, 易诗语, 李宜蓁, 邵海玲, 张红梅. 经胸右心声学造影预估肝硬化伴食管胃底静脉曲张内镜下治疗效果的初步研究[J]. 中华医学超声杂志（电子版）, 2022, 19(06): 514-520.
[3] 张红梅, 李春梅, 王胰, 张清凤, 丁戈琦, 邓燕, 林薿, 李文华, 尹立雪. 经胸右心声学造影不同右心房增压方式评估卵圆孔未闭隐匿性右向左分流的价值[J]. 中华医学超声杂志（电子版）, 2022, 19(06): 508-513.
[4] 付举一, 惠品晶, 丁亚芳, 颜燕红, 张白, 贺永明, 方琪. 对比增强经颅多普勒超声评估右向左分流的可行性[J]. 中华医学超声杂志（电子版）, 2020, 17(03): 255-261.
[5] 盛常睿, 陈赛君, 严利明, 胡晶晶, 洪芳芳, 贲志飞. 注射用六氟化硫微泡造影剂剂量与机械指数对孕鼠胎盘超声造影成像的影响[J]. 中华妇幼临床医学杂志(电子版), 2020, 16(03): 329-334.
[6] 田佳丽, 陈晓波. 卵圆孔未闭隧道特点对介入封堵术的影响因素分析[J]. 中华介入放射学电子杂志, 2023, 11(04): 346-351.
[7] 李燕伟, 黄大军, 伍洲, 张嬿, 康彧, 孔令秋. 曲折的右心声学造影一例[J]. 中华心脏与心律电子杂志, 2023, 11(03): 179-181.
[8] 娄宇轩, 华杨, 杨丰泽, 史倞, 孙伟, 孔祥清. 神经系统症状为主的房间隔缺损患者的特征及疗效分析[J]. 中华心脏与心律电子杂志, 2022, 10(02): 84-87.
[9] 娄宇轩, 孙伟, 孔祥清. 经导管卵圆孔未闭介入封堵术预防卒中的研究进展[J]. 中华心脏与心律电子杂志, 2022, 10(01): 23-26.
[10] 卜智斌, 叶萌, 洪丽杰, 姜鹏涛, 莫自楷. 超声介导的载药微泡对裸鼠卵巢癌皮下移植瘤的抑制作用[J]. 中华老年病研究电子杂志, 2021, 08(01): 20-24.
[11] 姜新鹏, 李晓明, 杨航, 宫一宸, 傅元豪, 傅瑜, 张喆. 单纯经胸超声心动图引导卵圆孔未闭封堵术早期安全性及有效性分析[J]. 中华脑血管病杂志(电子版), 2023, 17(04): 320-324.
[12] 尹琛俊, 张喆, 李晓明. 卵圆孔未闭相关血栓形成机制的研究进展[J]. 中华脑血管病杂志(电子版), 2023, 17(04): 307-311.
[13] 霍俊艳, 傅瑜. 卵圆孔未闭检测方法临床应用研究进展[J]. 中华脑血管病杂志(电子版), 2022, 16(05): 310-313.
[14] 姜新鹏, 张喆. 卵圆孔未闭相关隐源性脑梗死影像学特征的研究现状[J]. 中华脑血管病杂志(电子版), 2021, 15(02): 112-114.
[15] 赵欣, 邓燕. 卵圆孔未闭与不明原因脑卒中的研究进展[J]. 中华脑血管病杂志(电子版), 2020, 14(03): 163-166.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号