中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2018, Vol. 13 ›› Issue (7): 1212-1215.doi: 10.4103/1673-5374.235058

• 原著:脑损伤修复保护与再生 • 上一篇    下一篇

短暂性脑缺血发作患者有必要进行经食管超声心动图检查吗？

  

  • 收稿日期:2018-05-25 出版日期:2018-07-15 发布日期:2018-07-15

Is transesophageal echocardiography needed for evaluating tissue-based transient ischemic attack?

Mohamed Al-Khaled1, Björn Scheef1, 2, Toralf Brüning1   

  1. 1 Department of Neurology, University of Lübeck, Lübeck, Germany
    2 Department of Ophthalmology, University of Rostock, Rostock, Germany
  • Received:2018-05-25 Online:2018-07-15 Published:2018-07-15
  • Contact: Mohamed Al-Khaled, M.D.,Mohamed.al-khaled@neuro.uni-luebeck.de.

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摘要：

 

目前关于短暂性脑缺血（TIA）患者经食道超声心动图（TEE）心脏评估的资料很少。此次研究的目的是研究短暂性脑缺血患者的基于组织的经食道超声心动图表现。在此次为期4年的前瞻性研究中（2011-2014年），共纳入了1071例短暂性脑缺血患者（平均年龄70±13岁;女性占49.7％），其中288例接受了经食道超声心动图。经经食道超声心动图评估的短暂性脑缺血患者年龄较未经经食道超声心动图评估的患者小，既往脑卒中和心房纤颤发病率较低。 71例患者（25.7％）检出卵圆孔，25例患者（8.7％）检出13例患者（4.6％）房间隔动脉瘤和主动脉弓严重动脉粥样硬化斑块（4例和5例）。一名患者（0.3％）的经食道超声心动图检测到纤维瘤。在接受经食道超声心动图的288例患者中有17例（6％），经食道超声心动图评估认为有抗凝治疗的适应证，1例纤维瘤患者接受了心脏手术。住院期间，有7例患者出现卒中，27例患者复发短暂性脑缺血。在出院后3个月，接受与未接受经食道超声心动图评估的患者死亡率、脑卒中风险和复发短暂性脑缺血率相近。说明在短暂性脑缺血患者中进行基于组织经食道超声心动图检查有助于探查心源性栓塞，并可能指示是否需要抗凝治疗。

orcid:0000-0001-8406-5044(Mohamed Al-Khaled)

关键词: 经食管超声心动图, 短暂性脑缺血中风, 抗凝治疗

Abstract:

Transient ischemic attack (TIA) is a warning signal for stroke. A comprehensive evaluation of TIA may reduce the risk for subsequent stroke. Data on the findings of cardiac evaluation with transesophageal echocardiography (TEE) in patients with TIA are sparse. Our aims were to determine the frequency of TEE performance and to investigate the findings of TEE in patients with TIA based on the new definition of TIA (i.e., transient neurological symptoms without evidence of infarction). During a 4-year period (2011–2014), 1071 patients (mean age, 70 ± 13 years; female, 49.7%) with TIA were included in a prospective study and evaluated. Of 1071 consecutive patients suffering from TIA, 288 patients (27%) underwent TEE.The median time between admission and TEE was 6 days. Patients with TIA who were evaluated by TEE were younger (67 vs. 71 years, P < 0.001) than those who were not evaluated by TEE. They had a higher rate of sensibility disturbance as a TIA symptom (39% vs. 31%, P = 0.012) but a lower rate of previous stroke (15% vs. 25%, P = 0.001) and atrial fibrillation (2% vs. 21%, P < 0.001) than those who did not. Foramen ovale was detected in 71 patients (25.7%), atrial septal aneurysm in 13 patients (4.6%), and severe atherosclerotic plaques (grade 4 and 5) in the aortic arch in 25 patients (8.7%). One patient (0.3%) had a fibroma detected by TEE. In 17 of the 288 patients (6%) who underwent TEE, the indication for anticoagulation therapy was based on the TEE results, and 1 patient with fibroma underwent heart surgery. During hospitalization,7 patients experienced a subsequent stroke, and 27 patients had a recurrent TIA. At 3 months following discharge, the rates of readmission, stroke, recurrent TIA, and death were 19%, 2.7%, 4.2%, and 1.6%, respectively. The rates of mortality (0.9% vs. 1.8%, P = 0.7), stroke risk (1.9% vs. 3.0%, P = 0.8), and recurrent TIA (5.0% vs. 3.9%, P = 0.8) were similar in patients who underwent TEE and in those who did not. Performing TEE in patients with tissue-based TIA is helpful in detecting cardiac sources for embolism and may indicate for anticoagulation.

Key words: transesophageal echocardiography, transient ischemic stroke, anticoagulation, management, therapy change