偏头痛患者合并中量右向左分流卵圆孔未闭行介入封堵术的疗效分析  

Efficacy of interventional closure of patent foramen ovale in migraine patients with moderate right⁃to⁃left shunt

作　　者：张悦[1] 娄宇轩 王艺斐 黄婉琳 张浩[1] 史倞 盛燕辉[1,3] ZHANG Yue;LOU Yuxuan;WANG Yifei;HUANG Wanlin;ZHANG Hao;SHI Jing;SHENG Yanhui(Department of Cardiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029;Southeast University School of Medicine,Nanjing 211189;Center for Cardiovascular Diseases,the Affiliated Suzhou Hospital of Nanjing Medical University,Gusu School,Nanjing Medical University,Suzhou 215008,China)

机构地区：[1]南京医科大学第一附属医院心血管内科,江苏南京210029 [2]东南大学医学院,江苏南京211189 [3]南京医科大学附属苏州医院心血管病中心,南京医科大学姑苏学院,江苏苏州215008

出　　处：《南京医科大学学报（自然科学版）》2024年第2期191-196,共6页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家自然科学基金(81800313);南京医科大学姑苏学院引进人才项目(GSRCKY20210203)。

摘　　要：目的:通过对比介入封堵治疗偏头痛合并中、大量右向左分流(right⁃to⁃left shunt,RLS)卵圆孔未闭(patent foramen ovale,PFO)患者的手术难度与近期疗效,评价偏头痛伴中量RLS⁃PFO患者行介入封堵的可行性。方法:入选偏头痛合并中量或大量RLS⁃PFO并行介入封堵的患者95例,分析两组患者的偏头痛症状、封堵成功率、封堵难度、术后RLS量及术后头痛缓解水平的差异。结果:两组术前头痛影响测试⁃6(headache impact test⁃6,HIT⁃6)、偏头痛残疾评估量表(migraine disability as⁃sessment questionnaire,MIDAS)评分无统计学差异(P>0.05);两组封堵成功率无统计学差异(92.00%vs.98.57%,P=0.137),但中量RLS⁃PFO组术中第2根导丝使用率、心腔内超声利用率及X线曝光时间明显高于大量RLS⁃PFO组(P<0.01);中量RLS⁃PFO组术后3 d有效封堵率高于大量RLS⁃PFO组(86.96%vs.56.52%,P=0.008),两组间术后1个月、3个月、6个月RLS量及有效封堵率无统计学差异(P>0.05);两组患者术后6个月HIT⁃6和MIDAS评分较术前改善(P<0.001),但中量RLS⁃PFO组术后6个月HIT⁃6评分较大量RLS⁃PFO组下降(P=0.012),而MIDAS评分无统计学差异。结论:偏头痛合并中量RLS⁃PFO患者行介入封堵的手术难度较大量RLS⁃PFO高,但介入封堵后头痛缓解疗效两组相似。Objective:To evaluate the feasibility of interventional closure in migraine patients with moderate right⁃to⁃left shunt patent foramen ovale(RLS⁃PFO)by comparing the surgical difficulty and short⁃term efficacy between patients with moderate or large RLS⁃PFO.Methods:A total of 95 patients with migraine accompanied by moderate or large RLS⁃PFO who underwent interventional closure were selected.The differences inmigraine symptoms,closure success rate,closure difficulty,postoperative RLS volume and postoperative headache relief level were analyzed.Results:There was no significant difference in preoperative headache impact test⁃6(HIT⁃6)and migraine disability assessment questionnaire(MIDAS)scores between the two groups(P>0.05).There was no difference in closure success rate between the two groups(92.00%vs.98.57%,P=0.137),but the usage rate of the second guidewire,intracardiac ultrasound utilization rate,and X⁃ray exposure time were significantly higher in the moderate RLS⁃PFO group than in the large RLS⁃PFO group(P<0.01).The effective closure rate at 3 days after the procedure was higher in the moderate RLS⁃PFO group than in the large RLS⁃PFO group(86.96%vs.56.52%,P=0.008),but there were no differences in RLS volume and effective closure rate at 1 month,3 months and 6 months after operation between the two groups(P>0.05).The HIT⁃6 and MIDAS scores were improved at 6 months after the procedure compared to before the procedure in both groups(P<0.001),but the decrease in HIT⁃6 score at 6 months after the procedure was smaller in the moderate RLS⁃PFO group than in the large RLS⁃PFO group(P=0.012),while there was no difference in MIDAS score.Conclusion:The surgical difficulty of interventional closure in migraine patients with moderate RLS⁃PFO is higher than in patients with large RLS⁃PFO,but the efficacy of headache relief after interventional closure is similar between the two groups.

关 键 词：卵圆孔未闭 偏头痛 介入封堵术 右向左分流 

分 类 号：R541.1[医药卫生—心血管疾病]