隱源性缺血性腦卒中患者的食管超聲心動圖解析

繆英　李倩　劉軍梅

摘 要：目的 探討食管超聲心動圖（TEE）診斷隱源性缺血性腦卒中（CS）患者房間隔異常的特點。方法 收集我院CS患者181例，根據年齡分為<30歲組、31～50歲組、>51歲組。所有患者均行TEE檢查，觀察房間隔情況。結果 所有患者中，PFO患者63例，占34.81%，房間隔膨出瘤患者6例，占3.31%，房間隔膨出瘤并缺損患者19例，占10.50%，房間隔組織稀疏并分流患者24例，占13.26%；小于30歲組房間隔組織稀疏并分流患者4例，占44.44%；31～50歲組房間隔結構異常者以PFO居多，占33.33%；大于51歲組PFO最多，占37.36%。CS患者中房間隔異常的TEE超聲特點：①卵圓孔未閉類型：卵圓瓣較長，與房間隔組織貼合欠佳，有明顯裂隙，形似“隧道”樣；卵圓瓣較短，與房間隔組織貼合處有間隙。②房間隔膨出瘤或合并房間隔缺損，即房間隔組織菲薄，隨心臟舒縮活動膨向右房、左房或擺動于左右房之間，部分患者可合并房間隔小缺損。③房間隔組織薄弱、稀疏，形同“篩子”樣，可合并心房水平多股細小分流信號。結論 PFO是CS的重要致病原因之一，TEE作為目前診斷PFO和房間隔病變的首選方法，可精準描述房間隔結構和準確判斷心房水平的分流情況，為臨床盡早識別和預防腦血管卒中提供客觀依據。

關鍵詞：食管超聲心動圖；卵圓孔；房間隔膨出瘤；隱源性缺血性腦卒中

中圖分類號：R540.4+5；R743.3 文獻標識碼：A DOI：10.3969/j.issn.1006-1959.2018.22.048

文章編號：1006-1959（2018）22-0161-03

Analysis of Esophageal Echocardiography in Patients with Cryptogenic Ischemic Stroke

MIAO Ying，LI Qian，LIU Jun-mei，ZHAI Yan-fang，CHU Xiao-xu

（Department of Cardiology，Echo Room，People's Hospital of Yuxi City，Yuxi 653100，Yunnan，China）

Abstract：Objective To investigate the characteristics of esophageal echocardiography （TEE） in the diagnosis of atrial septal abnormalities in patients with cryptogenic ischemic stroke （CS）. Methods A total of 181 patients with CS in our hospital were enrolled. According to age， they were divided into groups of less than 30 years old， 31-50 years old， and older than 51 years old. All patients underwent a TEE examination to observe the interatrial septum. Results Among all patients， 63 patients with PFO， accounting for 34.81%， 6 patients with atrial fibrillation， accounting for 3.31%， 19 patients with atrial fibrillation and defect， accounting for 10.50%，There were 24 cases of sparse and shunted patients in the room， accounting for 13.26%； 4 cases of atrial septal tissue sparse and shunted in less than 30 years old， accounting for 44.44%； those with abnormal atrial septal structure in the 31-50 years old group were mostly PFO， accounting for 33.33%； More than 51 years old group PFO most， accounting for 37.36%. Characteristics of TEE ultrasound in patients with abnormal septal septal in CS：①Type of patent foramen ovale： the oval valve is long， and the atrial septal tissue is poorly fitted， with obvious fissures， resembling a "tunnel"； the oval valve is shorter， and there is a gap between the atrial septal tissue and the atrial septal tissue.②Room septal bulging tumor or combined atrial septal defect， that is， the atrial septal tissue is thin， with the expansion of the heart to the right atrium， left atrium or swing between the left and right rooms， some patients may have a small interatrial septal defect.③The compartments are weak and sparse， and they are similar to the "sieve". They can be combined with multiple small shunt signals at the atrial level.Conclusion PFO is one of the most important causes of CS. TEE， as the first choice in the diagnosis of PFO and atrial septal disease， can accurately describe the atrial septal structure and accurately judge the atrial shunt. To provide objective basis for clinical early identification and prevention of cerebrovascular apoplexy.

Key words：Esophageal echocardiography；Patent foramen ovale；Atrial septum bulge；Cryptogenic ischemic stroke

隱源性缺血性腦卒中（cryptogenic ischemic stroke，CS）是指經過系統常規檢查，臨床標準評估、高級評估和專項評估后，無法明確其發生原因的腦卒中[1.2]。中青年缺血性腦卒中人群中CS占比高達1/3，目前研究認為心臟卵圓孔未閉和房間隔膨出瘤與其密切相關[3，4]。……