Guo Yu-Zhu, Gao Yong-Sheng, Guo Zhen-Ni, Niu Peng-Peng, Yang Yi, Xing Ying-Qi
Neuroscience Center, Department of Neurology, First Hospital of Jilin University, Changchun, China.
Department of Cardiac Surgery, First Hospital of Jilin University, Changchun, China.
Ultrasound Med Biol. 2016 May;42(5):1124-9. doi: 10.1016/j.ultrasmedbio.2015.12.020. Epub 2016 Feb 28.
We evaluated 298 patients for right-to-left shunt (RLS) detection by contrast-enhanced transcranial Doppler at rest state (RS), during the conventional Valsalva maneuver (CM), and during the modified Valsalva maneuver (BM: blowing into the connecting tube of a sphygmomanometer at 40 mm Hg for 10 s) in random order, and the degree of RLS along the time of the first microbubble occurrence was recorded. The positive rates were 21.8%, 36.9% and 47.3% for RS, CM and BM, respectively (p < 0.001). BM resulted in a significantly higher positive rate (p = 0.010), and there was a significant difference between the two different methods of VM in terms of the degree of RLS detection (p < 0.001). Further, the first microbubble occurred later during BM than CM (10.22 ± 3.77 s vs. 9.44 ± 4.36 s, p < 0.05). This modified maneuver is an alternative to the conventional one, especially for those who cannot perform the conventional maneuver adequately, but are highly suspected of having RLS.
我们对298例患者进行了评估，通过对比增强经颅多普勒分别在静息状态（RS）、传统瓦尔萨尔瓦动作（CM）和改良瓦尔萨尔瓦动作（BM：以40 mmHg的压力向血压计连接管吹气10秒）下随机检测右向左分流（RLS），并记录首次出现微气泡时RLS随时间的程度。RS、CM和BM的阳性率分别为21.8%、36.9%和47.3%（p<0.001）。BM的阳性率显著更高（p = 0.010），两种不同的瓦尔萨尔瓦动作方法在RLS检测程度方面存在显著差异（p<0.001）。此外，首次出现微气泡的时间在BM时比CM时更晚（10.22±3.77秒对9.44±4.36秒，p<0.05）。这种改良动作是传统动作的一种替代方法，尤其适用于那些无法充分进行传统动作但高度怀疑有RLS的患者。
