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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72 ZHONGGUOYIXUEZHUANGBEI学术论著收稿日期：2018-10-28imaging for the detection of breast cancer in Chinese women[J].BMCCancer,2016,16(1):450. Razek NA,Essa AE.Role of low dose state ofmultislice CT mammography in the evaluation of postoperative and post-radiation changes[J].Egypt J RadiNuclMed,2016,47(4):1709-1720.程任捷,唐文成.多种超声技术与X射线钼靶联合诊断乳腺癌的应用价值[J].中国临床研究,2017,30(8):1123-1125.[16][17][文章编号] 1672-8270(2019)03-0072-04 [中图分类号] R445.1 [文献标识码] ADiagnostic value of RT-3DE combined with right heart cTTE in adult patients with PFO/LU Y an-fei, SONG Hai-guo, SU Hai-qing, et al//China Medical Equipment,2019,16(3):72-75.[Abstract] Objective: T o 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 cTTE examination. The assessments of two examination modes of two groups under the quiescent condition and V alsalva 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 V alsalva 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 (7 cases) and III grade (4 cases), and that under V alsalva 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.[Key words] Patent foramen ovale; Patent ductus arteriosus; Real-time three-dimensional echocardiography; Right heart contrast transthoracic-echocardiography; Adult[First-author’s address] Department of Ultrasound, National Hospital of Guangxi Zhuang Autonomous Region, Nanning 530001, China.[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cTTE检查，有助于成年人卵圆孔的诊断。
[关键词] 卵圆孔未闭；动脉导管未闭；实时三维超声心动图；右心声学造影；成年人DOI: 10.3969/J.ISSN.1672-8270.2019.03.020陆燕飞① 宋海国①* 苏海庆① 谭 臻① 黄 蔚① 杨立娟①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**基金项目：广西壮族自治区卫生和计划生育委员会科研项目(Z20170297)“实时三维超声心动图联合右心声学造影在成人PFO的诊断价值研究”①广西壮族自治区民族医院超声学科 广西 南宁 530001*通信作者：vista100@作者简介：陆燕飞，女，(1979- )，硕士，副主任医师，研究方向：心脏及外周血管超声诊断。
心脏卵圆孔未闭(patent foramen ovale，PFO)作为一种隐匿性疾病，患者缺乏显著的临床表现，且因常规的心电图及胸片检查不易发现此疾病而导致临床发现率低。
有研究显示，在成人所患的先天心脏异常中，PFO居于首位，同时研究也发现，脑卒中原因不明者与PFO存在高度关联性[1]。
常规心电图及胸部X射线片对于PFO的诊断无参考价值，心脏超声检查是明确是否存在PFO的可靠手段，虽然国内对PFO的诊断研究较多围绕声学造影展开，亦有部分研究[2]是针对食管超声心动图对PFO的诊断研究，而实时三维超声心动图(real time 3-dimensional echocardiography，RT-3DE)联合经胸右心声学造影(contrast transthoracic-echocardiography，cTTE)进行PFO的诊断实属罕见，其诊断价值尚未经过临床的充分验证。
为此，本研究中国医学装备2019年3月第16卷第3期 China Medical Equipment 2019 March V ol.16 No.3学术论著ZHONGGUO YIXUEZHUANGBEI73拟通过RT-3DE联合cTTE检查，回顾性分析100例确诊PFO病例的影像信息，对PFO的位置大小、毗邻关系和右向左分流(right-to-left shunt，RLS)的分流量进行评估，探讨RT-3DE联合cTTE相比于单纯cTTE在诊断PFO中的优越性，为临床医生治疗方案的选择提供可靠的影像学依据，并为其提供实验数据支持。
