卵圆孔未闭患者介入封堵术中导丝通过卵圆孔困难的影响因素分析

Influencing factors of the difficulty of guidewire passing through patent foramen ovale in percutaneous closure

钱晨旭 ¹王平 ¹毛治尉 ¹闫振富 ¹张涛 ¹豆倩云 ¹余欣 ¹朱铮铮 ²韩凌 ¹王东伟¹

扫码查看

作者信息

1. 郑州大学附属郑州中心医院心血管内科,河南郑州 450007
2. 郑州大学附属郑州中心医院超声科,河南郑州 450007
折叠

摘要

目的观察卵圆孔未闭(PFO)患者术前对比增强经颅多普勒超声声学造影(c-TCD)右向左分流(RLS)分级及经食管超声心动图(TEE)测量的PFO宽度,探讨PFO患者介入封堵术中导丝通过卵圆孔困难的影响因素.方法 2021年1月—2022年12月郑州大学附属郑州中心医院行经皮介入封堵术的PFO患者286例,术前均行c-TCD、经胸超声心动图声学造影(c-TTE)评定RLS分级,行TEE检查测量PFO宽度、长度.286例PFO患者中,术中导丝顺利通过卵圆孔者260例为通过顺利组,应用Swartz鞘协助导丝通过者26例为通过困难组.比较2组术前c-TCD RLS、c-TTE RLS、PFO宽度、PFO长度、PFO分型及手术时间;采用多因素logistic回归分析PFO患者介入封堵术中导丝通过卵圆孔困难的影响因素.结果通过顺利组手术时间[(34.20±12.80)min]短于通过困难组[(61.07±30.33)min](t=8.597,P＜0.001),PFO 宽度[(1.53±0.61)mm]大于通过困难组[(1.14±0.20)mm](t=-3.047,P=0.018),c-TCD RLS Ⅳ级比率(71.92％)、c-TTE RLS Ⅲ级比率(81.15％)均高于通过困难组(11.54％、38.46％)(x2=111.374,P＜0.001;x2=24.603,P＜0.001),PFO长度、PFO分型与通过困难组比较差异均无统计学意义(P＞0.05).c-TCD RLS 0级(OR=944.684,95％CI:75.962～11 748.277,P＜0.001)、c-TCD RLS Ⅱ 级(OR=72.026,95％CI:10.102～513.544,P＜0.001)、PFO 宽度≤1.14 mm(OR=0.265,95％CI:0.078～0.900,P=0.033)是卵圆孔患者介入封堵术中导丝通过卵圆孔困难的危险因素.结论 c-TCD RLS≤ Ⅱ级、PFO宽度≤1.14 mm的PFO患者介入封堵术中导丝通过卵圆孔困难的风险增大,需Swartz鞘协助.

Abstract

Objective To observe the right-to-left shunt(RLS)grade by contrast-enhanced transcranial Doppler ultrasound(c-TCD)and the patent foramen ovale(PFO)width by transesophageal echocardiography(TEE)before operation,and to investigate the influencing factors of the difficulty of guidewire passing through the foramen ovale during percutaneous closure of PFO.Methods Totally 286 PFO patients successfully underwent percutaneous closure in Zhengzhou Central Hospital Affiliated to Zhengzhou University from January 2021 to December 2022.c-TCD and transthoracic echocardiography(c-TTE)were performed before operation to evaluate RLS grade,and TEE was performed to measure the width and length of PFO.Among 286 patients with PFO,the guidewire passed through the foramen ovale successfully in 260 patients(successful group),and the Swartz sheath was used to assist the guidewire to pass through in 26 patients(difficult group).The preoperative RLS by c-TCD,RLS by c-TTE,width of PFO,length of PFO,PFO classification and operation lasting time were compared between two groups.Multivariate logistic regression analysis was conducted to evaluate the influencing factors of the difficulty of the guidewire passing through the ovale foramen in percutaneous closure.Results The operation lasting time was shorter in successful group[(34.20±12.80)min]than that in difficult group[(61.07±30.33)min](t=8.597,P＜0.001),the width of PFO was greater in successful group[(1.53±0.61)mm]than that in difficult group[(1.14±0.20)mm](t=-3.047,P=0.018),the rates of RLS gradeⅣ by c-TCD and RLS grade Ⅲ by c-TTE were higher in successful group(71.92％,81.15％)than those in difficult group(11.54％,38.46％)(x2=111.374,P＜0.001;x2=24.603,P＜0.001),and there were no significant differences in the length of PFO and PFO classification between two groups(P＞0.05).RLS grade 0 by c-TCD(OR=944.684,95％CI:75.962-11 748.277,P＜0.001),RLS grade Ⅱ by c-TCD(OR=72.026,95％CI:10.102-513.544,P＜0.001),and width of PFO ≤1.14 mm(OR=0.265,95％CI:0.078-0.900,P=0.033)were the risk factors of difficulty of guidewire passing through the foramen ovale in percutaneous closure.Conclusion RLS grade ≤ Ⅱ by c-TCD and PFO width ≤1.14 mm increase the difficulty of the guidewire passing through the foramen ovale in percutaneous closure of PFO,and Swartz sheath is recommended to use.

关键词

卵圆孔未闭/介入封堵术/对比增强经颅多普勒超声声学造影/经食管超声心动图/右向左分流/卵圆孔未闭宽度

Key words

patent foramen ovale/percutaneous closure/contrast enhanced transcranial Doppler/transesophageal echocardiography/right-to-left shunt/width of patent foramen ovale

引用本文复制引用

基金项目

河南省医学科技攻关计划联合共建项目(LHGJ20220865)

出版年

2024

中华实用诊断与治疗杂志

中华预防医学会河南省人民医院

中华实用诊断与治疗杂志

CSTPCD

影响因子：1.276

ISSN：1674-3474

参考文献量16

段落导航