Wang Si-Bo, Wang Xiao-Cong, Ma Yan, Liu Kang-Ding, Xing Ying-Qi
Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.
Department of Echocardiography, Cardiovascular Center, The First Hospital of Jilin University, Changchun, China.
PLoS One. 2017 Apr 6;12(4):e0175049. doi: 10.1371/journal.pone.0175049. eCollection 2017.
Contrast-enhanced transcranial Doppler (c-TCD) has been used to detect right-to-left shunts (RLS) because it is highly sensitive and cost-effective. The use of provocation maneuvers, such as physiologic maneuvers (e.g., coughing) and the Valsalva maneuver (VM) to transiently increase right atrial pressure and induce RLS increases the sensitivity of RLS detection. In this study, we sought to determine whether coughing is as effective as the VM in aiding the detection of RLS. We evaluated 162 subjects for RLS, using c-TCD under three different conditions: (i) resting state, (ii) coughing, and (iii) modified VM (m-VM), which involved blowing into a tube connected to a sphygmomanometer at 40 mmHg for 10 s. The positive rate of RLS detection with the m-VM was significantly higher than that with coughing. In addition, a difference between the two maneuvers was observed in terms of the degree of RLS seen. The m-VM should be widely used to detect RLS, because it is reliable, standardized, and cost-effective.
对比增强经颅多普勒（c-TCD）已被用于检测右向左分流（RLS），因为它具有高敏感性且性价比高。使用激发动作，如生理动作（如咳嗽）和瓦尔萨尔瓦动作（VM）来短暂增加右心房压力并诱发RLS，可提高RLS检测的敏感性。在本研究中，我们试图确定咳嗽在辅助检测RLS方面是否与VM同样有效。我们使用c-TCD在三种不同条件下评估了162名受试者的RLS：（i）静息状态，（ii）咳嗽，以及（iii）改良的VM（m-VM），即对着连接到血压计的管子以40 mmHg吹气10秒。m-VM检测RLS的阳性率显著高于咳嗽时。此外，在观察到的RLS程度方面，两种动作之间存在差异。m-VM应被广泛用于检测RLS，因为它可靠、标准化且性价比高。
