卵圆孔未闭合并不明原因栓塞性卒中的高危因素及食管超声引导的封堵效果分析  

Analysis of the risk factors of embolic strokes of undetermined source of patent foramen ovale with unknown cause and the effect of transesophageal echocardiography guided closure

作　　者：李少珂[1] 张申伟 张鹃鹃[2] 刘博 蔡逸群[1] 王林宁 左龙[1] 边涛[1] LI Shaoke;ZHANG Shenwei;ZHANG Juanjuan;LIU Bo;CAI Yiqun;WANG Linning;ZUO Long;BIAN Tao(The Seventh People's Hospial of Zhengzhou,Zhengzhou 450016,China;The Second Afiliaed Hospial of Zhengzhou University,Zhengzhou 450003,China)

机构地区：[1]郑州市第七人民医院,河南郑州450016 [2]郑州大学第二附属医院,河南郑州450003

出　　处：《中国实用神经疾病杂志》2021年第19期1733-1741,共9页Chinese Journal of Practical Nervous Diseases

摘　　要：目的探讨卵圆孔未闭(PFO)并发不明原因栓塞性卒中(ESUS)的高危因素和食管超声引导下卵圆孔未闭封堵的治疗效果。方法选取2018-08—2020-07在郑州市第七人民医院手术室由食管超声引导下封堵PFO患者92例为外科组,同期在心内科导管室X-ray下行PFO封堵341例为介入组。记录并比较2组患者临床资料、封堵成功率、并发症发生率。外科组中有ESUS史39例为ESUS组,未发生ESUS的53例为非ESUS组,比较2组临床资料、N末端脑钠肽前体浓度(NT-proBNP)、同型半胱氨酸(Hcy)浓度。结果外科组和介入组在年龄、性别构成比、体重指数、复杂PFO构成比、术后住院时间、封堵成功率、房颤发生率、急诊开胸手术、残余右向左分流发生率差异均无统计学意义(P>0.05)。外科组急诊开胸1例无脏器功能受损,介入组2例急诊开胸病例术后并发重要脏器功能严重损伤。外科组内比较,ESUS组和非ESUS组年龄、体重指数、血脂紊乱率、高血压等发生率差异均无统计学意义(P>0.05);ESUS组男性比例、复杂PFO构成比和右向左分流发生率、NT-proBNP和Hcy浓度明显高于ESUS组(P<0.05)。结论在手术室由食管超声引导的PFO经皮封堵具有和X-ray下封堵相同的高手术成功率和低并发症发生率。食管超声引导的PFO封堵不仅避免了X-ray和造影剂的不良反应,还能够明显降低并发症的严重程度,食管超声引导的PFO经皮封堵是一项安全、有效、可重复的技术。男性、复杂PFO、NT-proBNP、Hcy是预测PFO患者并发ESUS的高危因素。Objective To investigate the risk factors of patent foramen ovale(PFO)complicated with embolic strokes of undetermined source(ESUS)and the therapeutic effect of transesophageal echocardiography guided closure of patent foramen ovale.MethodsIn Zhengzhou Seventh People’s Hospital,92 patients with PFO were closed under transesophageal echocardiography guidance in the operating room from August 2018 to July2020,which was the surgical group.A total of 341 patients with PFO closure under X-ray in the catheter operating room in Zhengzhou Seventh People’s Hospital from August 2018 to July 2020 were selected as the interventional group.Clinical data,success rate of closure and complication rate were recorded and compared between the two groups.The surgical group consisted of 92 patients,39 of whom had history of ESUS,which was called ESUS group.Among the 92 patients in the surgical group,53 patients did not have ESUS,which was the non-ESUS group.The clinical data,the concentration of N-terminal pro-B-type natriuretic peptide(NT-probNP)and the concentration of homocysteine(Hcy)of the two groups were compared.ResultsThere were no significant differences between the surgical group and the intervention group in age,sex composition ratio,body mass index,complex PFO composition ratio,postoperative hospital stay,success rate of closure,incidence of atrial fibrillation,emergency thorax operation,and incidence of residual right-left shunt(P>0.05).In the surgical group,1 case of emergency thoracotomy had no organ function damage,while in the other group,2 cases of emergency thoracotomy had serious organ function damage after operation.There were no significant differences between ESUS group and non-ESUS group in age,body mass index,dyslipidemia rate,hypertension and other complications(P>0.05),and the proportion of men in ESUS group was significantly higher than that in non-ESUS group(P<0.05).The composition ratio of complex PFO and the incidence of RLS in ESUS group were significantly higher than those in non-ESUS group(P<0.05

关 键 词：卵圆孔未闭 不明原因栓塞性卒中 经食管超声心动图 经食管超声心动图声学造影 N末端脑钠肽前体 同型半胱氨酸 右向左分流 

分 类 号：R541.1[医药卫生—心血管疾病]