cTCD在中青年隐源性卒中患者的应用研究

发布时间：2018-02-21 16:14

本文关键词： 卵圆孔未闭隐匿性卒中经颅多普勒对比增强试验经食道超声心动图　出处：《山西医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:对小于55岁的隐源性卒中(cryptogenic stroke CS)患者行经颅多普勒对比增强试验(contrast-enhanced transcranial doppler,cTCD)和经食道超声心动图(transesophageal echocardiography,TEE)判断卵圆孔未闭(patent foramen ovale PFO),比较二者的优劣,并总结相关CS患者的磁共振成像的特点,为PFO相关性缺血性卒中的诊断提供线索。方法:本研究选取2014年1月至2016年12月山西省人民医院神经内科收治的不明原因脑卒中患者49例,所有患者均先后进行了cTCD和TEE检查,常规检测TCD,寻找最佳血管为监测血管,cTCD用1ml空气、8ml生理盐水及患者自身血液1ml制作的激活盐水作为造影剂,结合咳嗽及valsalva动作,观察大脑中动脉频谱,记录10s内探测到微气泡信号,在双侧大脑中动脉记录到5个或5个以上气泡信号记为阳性,其中29例患者cTCD和TEE检查结果均为阴性,18例患者cTCD和TEE结果均为阳性,2例患者cTCD结果阳性而TEE未发现微气泡信号。将双阳性患者记为A组,双阴性患者记为B组,由另一名影像医师评价颅脑DWI成像,按梗死数目多少,两组患者的分别分为单发和多发。按梗死分布特点,分为前循环、后循环、前后循环和双前循环,探讨其影像学的特点。结果:以经食道超声作为标准,经颅多普勒诊断PFO的灵敏度为100%,特异度为93.1%。按梗死灶多寡,AB两组患者组间比较差异有显著性(P0.05)。前者更易发生多发的梗死。按梗死分布特点,前后循环之间与后循环和前后循环之间进行组间两两比较,两组间差异均有统计学意义,PFO相关的脑卒中更容易累及后循环。结论:用cTCD诊断中青年隐源性卒中患者的卵圆孔未闭具有高度的敏感性和特异性,且操作安全,可作为卵圆孔未闭筛查的有效手段,能大大减少经食道超声带来的痛苦和并发症。PFO相关性脑卒中和其他来源的梗死相比较,后循环的多发性梗死较多见,这种临床和影像学特点能为临床诊断提供线索。
[Abstract]:Objective: to compare the advantages and disadvantages of contrast-enhanced transcranial doppler echocardiography (TCD) and transesophageal echocardiography (TEE) in patients with cryptogenic stroke with cryptogenic foramen oval foramen ovale (foramen ovale PFOE), and to compare the advantages and disadvantages of contrast-enhanced transcranial doppler echocardiography (TCD) and transesophageal echocardiography (TEE) in the diagnosis of foramen ovale PFOE in patients with cryptogenic stroke. The characteristics of magnetic resonance imaging in patients with CS were summarized. Methods: from January 2014 to December 2016, 49 patients with unexplained cerebral apoplexy treated in Department of Neurology, Shanxi Provincial people's Hospital, were examined by cTCD and TEE respectively. Routine detection of TCD was performed to find the best blood vessel for monitoring vascular cTCD with 1 ml of normal saline in air and 1 ml of activated saline made in patient's own blood as contrast agent. Combined with cough and valsalva movements, the spectrum of middle cerebral artery was observed. Microbubble signals were detected within 10 seconds, and 5 or more bubbles were recorded in bilateral middle cerebral arteries as positive. The results of cTCD and TEE in 29 cases were all negative. The results of cTCD and TEE in 18 cases were both positive. The results of cTCD were positive in 2 cases, but no microbubble signal was found in TEE. The double positive patients were recorded as group A and the patients with double negative as group B. According to the number of infarction, the patients in the two groups were divided into single and multiple according to the number of infarction, according to the distribution of infarction, they were divided into anterior circulation, posterior circulation, posterior circulation and double anterior circulation. Results: transesophageal ultrasound was used as the standard. The sensitivity of transcranial Doppler in the diagnosis of PFO was 100 and the specificity was 93.1. There was a significant difference between the two groups according to the number of infarcts and the number of infarcts in AB group. The former was more prone to multiple infarcts, and according to the characteristics of infarct distribution, there was a significant difference between the two groups. A comparison was made between the two groups between the front and back cycles and between the back and back cycles, The difference between the two groups is statistically significant. PFO-related stroke is more likely to involve posterior circulation. Conclusion: the diagnosis of patent foramen ovale with cTCD in young and middle-aged patients with cryptogenic stroke is highly sensitive, specific and safe. Can be used as an effective means to screen the foramen ovale, can greatly reduce the pain and complications caused by transesophageal ultrasound. PFO-related stroke compared with other sources of infarction. This clinical and imaging feature can provide clues for clinical diagnosis.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R743.3

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