Abstract:

Objective To analyze the influence of supine position and sitting position in detecting right-to-left shunt (RLS) using contrast enhanced transcranial Doppler (cTCD), to optimize cTCD procedure. Methods Patients with migraine from July, 2014 to February, 2017 were selected. The baseline data and clinical features data were collected. All participants underwent cTCD examination, which was done in state of rest and Valsalva maneuver in every position. The results of cTCD, the occurring time and number of RLS microbubble in different state in two positions were compared. Results Finally, 254 patients (57.1% were female) were included in this study, with 143 (56.3%) ones with RLS. The diagnosis positive rate of RLS in state of rest (38.6% vs 31.1%) and valsalva maneuver (56.3% vs 45.3%) both increased in sitting position, compared with that in supine position. Compared with supine position, sitting position shortened the occurring time of first microbubble (7.56±2.12 vs 9.89±2.31 s, P =0.003; 5.94±1.28 vs 7.34±2.23 s, P <0.001) and increased the total number of microbubbles [2 (0-6) vs 5(4-9); 9 (4-14) vs 10 (6-33); both P <0.001] in state of rest and valsalva maneuver. Compared with the state of rest, Valsalva breathing shortened the occurring time of first microbubble (both P <0.001) and increased the total number of microbubbles (both P <0.001) in supine and sitting position. Conclusions Sitting position is superior to supine position in detecting and quantitative analysis of RLS using cTCD.

Key words: Contrast enhanced transcranial Doppler; Right-to-left shunt; Position

摘要：

目的 对比平卧位与坐位时，经颅多普勒增强试验（contrast enhanced transcranial Doppler，cTCD）对 于偏头痛患者右向左分流（right-to-left shunt，RLS）的筛查及定量分析的影响。 方法 纳入2014年7月-2017年2月门诊就诊的偏头痛患者。收集患者基线信息及临床特征。所有入 组患者均于平卧位及坐位时行cTCD检查。每个体位均行两步操作，包括平静呼吸及配合Valsalva呼 吸。比较坐位和平卧位cTCD及不同呼吸状态下RLS栓子出现的时间和数量。 结果 研究纳入254例患者，其中143例存在RLS（56.3%）。与平卧位相比，坐位平静呼吸（38.6% vs 31.1%）和Valsalva呼吸（56.3% vs 45.3%）情况下RLS的诊断阳性率都有所提升。与平卧位相比，坐 位明显缩短了平静呼吸、Valsalva呼吸第一个栓子出现的时间（7.56±2.12 s vs 9.89±2.31 s，P =0.003； 5.94±1.28 s vs 7.34±2.23 s，P＜0.001）及增加了栓子出现的数量[2（0～6）vs 5（4～9）个；9（4～14） vs 10（6～33）个，均P＜0.001）。同时，与平静呼吸相比，Valsalva呼吸缩短了平卧位、坐位第一个栓子 出现的时间（均P＜0.001）及增加了栓子出现的数量（均P＜0.001）。 结论 与传统平卧位比较，坐位更有助于cTCD检查中RLS的筛查及定量。

关键词: 经颅多普勒增强试验; 右向左分流; 体位