摘要
目的 联合应用经颅多普勒发泡试验(cTCD)和经胸超声心动图声学造影(cTTE)技术,评估不同分级卵圆孔未闭(PFO)伴偏头痛患者之间脑血流动力学参数的变化.方法 选取空军军医大学第二附属医院的偏头痛患者85名,联合应用 cTCD和cTTE判断受检者是否存在PFO导致的右向左分流(PFO-RLS)并根据分级标准进行分流程度分级(0、Ⅰ、Ⅱ、Ⅲ级).同时应用TCD分别观察Valsalva动作(VM)前后大脑中动脉(MCA)收缩期峰值血流速度(Vs)、平均血流速度(Vm)、舒张期峰值血流速度(Vd)、阻力指数(RI)和搏动指数(PI)等超声参数的特征,并对比分析PFO-RLS 0级与PFO-RLS Ⅰ、Ⅱ、Ⅲ级患者之间以上超声参数的差异.结果 85例受检者中,偏头痛伴PFO-RLS 0级患者13例,偏头痛伴PFO-RLS Ⅰ级患者34例,偏头痛伴PFO-RLS Ⅱ 级患者17例,偏头痛伴PFO-RLSⅢ 级患者21例.结果 显示VM前偏头痛伴PFO-RLS Ⅱ级患者比偏头痛伴PFO-RLS 0级患者的Vs、Vm、Vd血流速度增快,差异有统计学意义(P<0.05);VM后偏头痛伴PFO-RLS Ⅲ级者比偏头痛伴PFO-RLS 0级患者的Vm、Vd增快,差异有统计学意义(P<0.05).结论 不同分级PFO-RLS伴偏头痛患者之间脑血流变化趋势不同,根据脑血流特征性变化,可为偏头痛患者的病因诊断及治疗提供一定的临床理论依据.
Abstract
Objective To investigate the changes in cerebral hemodynamic parameters in patients with migraine and different grades of patent foramen ovale(PFO)using contrast-enhanced transcranial Doppler(cTCD)foaming test and contrast-enhanced transthoracic echocardiography(cTTE).Methods A total of 85 patients with migraine in our hospital were enrolled,and cTCD and cTTE were used in combination to determine whether a subject had right to left shunt(PFO-RLS)caused by PFO,which was graded according to the grading criteria(grades 0,Ⅰ,Ⅱ,and Ⅲ).Meanwhile,TCD was used to observe the ultrasound parameters of the middle cerebral artery before and after Valsalva maneuver(VM),in-cluding peak systolic blood flow velocity(Vs),mean blood flow velocity(Vm),peak diastolic blood flow velocity(Vd),resistance index,and pulsatility index,and these ultrasound parameters were compared between grade 0 PFO-RLS and grade Ⅰ/Ⅱ/Ⅲ PFO-RLS.Results Among the 85 subjects,13 patients had migraine with grade 0 PFO-RLS,34 patients had migraine with grade I PFO-RLS,17 patients had migraine with grade Ⅱ PFO-RLS,and 21 patients had migraine with grade Ⅲ PFO-RLS.The results before VM showed that compared with the patients with migraine and grade 0 PFO-RLS,the patients with migraine and grade Ⅱ PFO-RLS had significant increases in Vs,Vm,and Vd(P<0.05),and the results after VM showed that compared with the patients with migraine and grade 0 PFO-RLS,the patients with migraine and grade Ⅲ PFO-RLS had significant increases in Vm and Vd(P<0.05).Conclusion There are different changing trends of cerebral blood flow in patients with migraine and different grades of PFO-RLS,and the characteristic changes in cere-bral blood flow can provide a certain clinical theoretical basis for the etiological diagnosis and treatment of patients with mi-graine.
维普
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