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目的:对比经食管超声心动图造影(TEE)、经胸超声心动图造影(TTE)在检测隐源性脑卒中及偏头痛患者卵圆孔未闭右向左分流(PFO-RLS)的效果。方法:选取2015年4月至2016年4月延安大学咸阳医院收治的隐源性脑卒中及偏头痛伴PFO-RLS患者50例,所有患者均先、后进行TTE和TEE造影,TTE造影检测频率为2~4 MHz,TEE造影检测频率为7 MHz。对比两种检查方法对于隐源性脑卒中及偏头痛患者的PFO-RLS检出率、半定量分流分级程度、检查准确率及造影并发症发生率。结果:TTE造影对PFO-RLS的检出率、半定量分级均显著高于TEE造影,差异有统计学意义(均P<0.05)。TTE造影无并发症及不适症状,且显著低于TEE造影的并发症发生率(P<0.05)。TTE造影检出PFO-RLS的特异度、灵敏度及准确率也显著高于TEE(P<0.05)。结论:TTE造影对隐源性脑卒中及偏头痛患者PFO-RLS检出率及准确率高,并发症少,半定量分流程度更精确,较TEE造影技术更具优势,值得临床推广应用。
Objective: To compare the effects of transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) in the detection of patent foramen ovale right-to-left shunt (PFO-RLS) in patients with cryptogenic stroke and migraine. Methods: From April 2015 to April 2016, 50 patients with cryptogenic stroke and migraine with PFO-RLS were enrolled in Xianyang Hospital, Yan’an University. TTE and TEE imaging and TTE imaging were performed in all patients. For 2 ~ 4 MHz, TEE contrast detection frequency is 7 MHz. Comparing the detection rate of PFO-RLS, semi-quantitative shunt grading, examination accuracy and incidence of contrast-induced complications in patients with cryptogenic stroke and migraine compared with the two methods. Results: The detection rate and semi-quantitative classification of PFO-RLS by TTE angiography were significantly higher than TEE angiography (all P <0.05). There was no complication or discomfort in TTE contrast and the incidence of complications was significantly lower than that of TEE (P <0.05). The specificity, sensitivity and accuracy of PFO-RLS detected by TTE were also significantly higher than those of TEE (P <0.05). Conclusion: The detection rate and accuracy of PFO-RLS in patients with cryptogenic stroke and migraine are higher than those without. Complication is less and the degree of semi-quantitative shunt is more accurate than TEE. It is worthy of clinical application.